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UIR11'aInC. BEAC i <br /> ' <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Sampler(Print Name) Dale Form No. <br /> _ � ANALYSES of <br /> Project No. Sampler(Signature) <br /> j co <br /> Afilia <br /> a LProjcLocation , <br /> a <br /> -------------------- <br /> Sa le Nolldentifcation Bate Time Lab No. z REMARKS <br /> 25 <br /> Relinquished by:(Signature/Affiliation) <br /> Date Time R ived by:(SignaturelA I' tion Date Time <br /> Reli ish y:(SignaturelAifilia#ion) D to Time ived by:(Signa! relA iliation) fit, i <br /> *Dae <br /> Time <br /> � � 'u•v�V�c� �i�1�% �jo��'.► <br /> Reli ish y:( ign t e(Aifili tion) Date Time Receiv by:(Signatur Affiliation) aa)e Time <br /> lD <br /> /f <br /> Report To: ` _ Bili to: ULTRAMAR INC, <br /> 525 West Third Street <br /> r Art�,^ Attention CA 53230 <br /> t'� "'�lt� Attention: <br /> w PINK:Originator Copy '2'°°"ft <br /> WHITE:Return to Client with Report YELLOW:Laboratory Copy g <br />