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Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> uifrarr�8r � .j5) <br /> 17 <br /> J <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> ANALYSES of <br /> Project No Sampler(Signature) <br /> k7 <br /> Project Location a 4 Affiliation <br /> 0 <br /> t�a <br /> U <br /> W Z 2 O <br /> Sample No/identification Date Time Lab No m z ° REMARKS <br /> 1 *21 <br /> EIT <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Ze, a n A V,yca�2.-'n <br /> lmquish by (Signa# re/Affiliation) Date TimeR iv by (Signature/Affiliation) Date Time <br /> �� a 0 6 Jq <br /> uis y (Signature/Affiliation) Date Tirpe Received by (Signature/Affiliation) ate Time <br /> C � <br /> Report To Bi to UL_TRAW4R INC <br /> 525 West Third Street <br /> Hanford, CA 93230 <br /> 6,116) 6! P, z Attention <br /> '!�/ s' I <br /> WHITE Ret rvo Pent with Repo II YELLOW Laboratory Cop PI iginato Co <br />