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u �_.flalf Inc. EE.,ON <br /> CHAIN OF CUSTODY REPORT <br /> i <br /> Beacon Station No. Sampler(Print Name) ate Form No <br /> ANALYSES of <br /> Project No. Sampler( igriature) <br /> �l2LLcc01 <br /> Project Location Affil' ion ro <br /> � o <br /> Sarr+ le Noildentification Date Time Lab!fin. � � Z REMARKS <br /> A? iv �' if <br /> 61 1A 14- <br /> Relinquished by:(Signatur Affiliation) Date Time R eived by:(Signature/Affiliation) Date Time <br /> ��� 5 L LDO <br /> Rel' ish :(Signature/Affiliation) Date Time IWeived by:(Skjnatur ffiliation) ate Time <br /> R li fished by:(S ignature/Afflialion) Date Time Received by:(Signature/ liation) Date Time <br /> Report To: Bill to: ULTRAMAR INC. <br /> 525 West Third Street <br /> J Hanford,CA 93230 <br /> c,/2nAttention: e. dam,., )a <br /> WHITE: Return to Client with Report YELLOW:Laboratory Copy PINK:Originator Copy 324M W <br />