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ufframar Inc. � <br /> V41 -71 BEACON <br /> urmi■nwr <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Sam er(Print Date Form No. <br /> l <br /> �i ANALYSES Z of <br /> Project No. S miller(Si ure) <br /> t2 �� ✓ � � <br /> Project Lanon _ i bn <br /> 0 <br /> E il <br /> Sample Noildentification Date Time Lab No. m z°I REMARKS <br /> �7 6-3 -- 0( Id zr- <br /> 5--10 � <br /> 'Oft 7 <br /> y <br /> z� <br /> 07 <br /> -60V7 z <br /> Pell quished ignat r ffitiation) Date Time Received by:(Signature/Affiliation) Date Time <br /> a. <br /> elinqui hed by: �gnature/Affiliation) a e Time Received by gnature/Affiliation a Time <br /> Relinquished by:(Signature/Affiliation) Date Time Reol <br /> ived by: (Signature/Affiliation) Date Time <br /> Report To: U U Bill to ULTRAMAR INC. <br /> 525 West Third Street <br /> Hanford,CA 93230 / f <br /> of 7z-- Attention: _-. 1' <br /> WHITE: Return to Client with Report YELLOW:Laboratory Copy PINK:Originator Copy 32-ON3 M <br />