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ultriar Inca <br /> CHAIN OF CUSTODY REPORT C V&,- 7 BEACON <br /> MUM <br /> W <br /> Beacon Station No. Sa ler(Print Na ) Date Form No. <br /> r7 �� ANALYSES � S'� of <br /> Project No. m ter(S' bture <br /> 2-- 12 a4l <br /> Project Location 0 7, <br /> G C ✓ x O <br /> LU M0 <br /> i- id. <br /> Sample NoJldentificata <br /> n Date Time Lab No. z°I REMARKS <br /> 127 <br /> _15_ B <br /> 07 4,7 <br /> S --13�0 0 7:l <br /> -3(--) 07) 33 v7 <br /> S - 8 07; ,39 0L { <br /> Reli uished • Sign re/Affiliation) Date Time Received by: (ftnalur`e/Afliliation) Date Time <br /> nqu' ed :(Signature/Affiliation) to Time Received :ftnalurelAfliliation)/ Liu ! alb Time <br /> i� Relinquished by:(Sig nature/Affiliation) Date Time Recel ed by: (SignaturedAflitiation) Date Time <br /> -c- -? �Dvt4,4 L-tG <br /> 44 <br /> ReportTo: Bill to: ULTRAMAR <br /> a-r �, 525 West Third Street <br /> k Hanford, CA 93230 <br /> Attention: "4 �"f <br /> ft 9- 2y7v <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy 32-0003 M <br />