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Am' ar <br /> , . -i, ...r u w r ..Inc. B CON <br /> CHAIN OF CUSTODY REPORT <br /> F <br /> i�aea�r <br /> Beacon station No Samp r(Print Name) Date Form No 1 <br /> I q 1 ANALYSES 7 /7-001 of 2 <br /> P(ojectf ! Sam (Signature) <br /> 14119 , q1 � <br /> Project Lavation Affdiatan <br /> Sock fore C �0217 ) j 1-A1 ) tiL o <br /> x o <br /> Sawle NoMentificallon Date Time Lab No ~ r 1 1 zi REMARKS <br /> 1vr11w, Okau zoo►, <br /> 5-111-ou f ! z fp-o <br /> 5 -11-oo / v;l5 <br /> W`Cos-/ —MtV6 5--ij-0a lI :`(t7 <br /> Reh hed by (Signature/ filiation) Date Time Received by (S�gnature/Atidiation) Date Time <br /> tivi7o <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Afhliabon) Date Time Received by (Signature/Affihalion) Date Time <br /> i9 <br /> Report To Bill to ULTRAMAR INC <br /> 14 U 121 z 525 West Third S(reet <br /> Hanford,CA 93230 <br /> v Attention l <br /> Y <br /> WHITE. Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy "'°°""° <br />