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� ti t� t• tl� t� t� A <br /> V mar Inc. B ON <br /> CHAIN OF CUSTODY REPORT 1,23 7 <br /> int <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> Z4� �/_� ANALYSES <br /> Project No Sa pler(S ature) <br /> Project Location Affiliatio5;;� n <br /> en <br /> A9W <br /> 8 47 <br /> Uk AV x o <br /> 2 <br /> Sample NoAdentification Date Time Lab No m a z° REMARKS <br /> 2—a--w- 09 '30 <br /> i <br /> 4quis'hed <br /> eh uish (Signatur filiation) Date Time Receivedby (SignaturelAffihation) Date Time <br /> elmb ignature/Aftiliatton) Date Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Alliliation) Date Time Recei by (SignaturelAffi ation) Dat Time <br /> Report To Bd ULTRAMAR INC <br /> 525 West Third Street <br /> YHanford,CAL93230 <br /> _ .31 7L— Attention r, �r%d <br /> WHITE, Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy <br />