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Ultrilar Inc. BEPCO4l <br /> CHAIN OF CUSTODY REPORT q�16,S <br /> unranir <br /> Beacon Station No Sampler print Name) Dat Form No <br /> ANALYSES y"111 of Z_ <br /> Protect No Sampler(Sign ure) t`L04:5t" <br /> 21- 73q ,45��z` <br /> Protect LocationAffiliation , <br /> Z44E." U3 rr�rnA►�1 [� — v lac i t c.i�vtil ��7 T5 <br /> o <br /> w = = <br /> Sample No/Identification Date Time Lab No m z REMARKS <br /> 2) <br /> /yIrfJ " ,Z ^` <br /> Z5 S-o <br /> Inw - <br /> Relinquish y ( ature/Affiliation) uDto Time Receiv� y (SignalurelQ#ilhaiionj D to Time <br /> Relingyisrpci by�Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> 19 <br /> Relin uished by (Signature/Affiliation) D to Time Received by (Signature/Affiliation) Date <br /> Mme <br /> 4R rt To �I� k�ICHCa�L,� �gI(v�-7&Z-211U Bill to ULTRAMAR INC <br /> 525 West Third Street <br /> 1050 MGL-00y 1,.tij, 4VI(60 Fft 7R.,-7630 Hanford, CA 93230 �— <br /> 9f367b <br /> Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 60071190 <br />