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Ultramar Inc. BEACON "N,,,, <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Sampler(Print Name) Date TFcWm No. <br /> ANALYSES of <br /> Project No. Sampler(Signature) <br /> 15 <br /> Project Location Affiliation c <br /> qno S. GherskP'P ° <br /> 0 <br /> 2 .92 0 <br /> SamWe No./Identification Date Time Lab No. m 2 <br /> CL z k I 1 3 S�4REMARKS <br /> 0 <br /> W- <br /> MW <br /> i s 045 <br /> 04c.O <br /> 1_!�5 <br /> y <br /> w- t <br /> Relinquished by:(Signature/Affiliation) Date Time 7iv y:(Signature/ ffiliati D to Time <br /> -15 <br /> -, <br /> ed by:(Signatuco <br /> eld iaion) Date Time aedby: inatureAffilia on Dafe Time <br /> - 10 <br /> inquish y:(Signatu e/Affiliation) Dae Time Received by:(Signature/Affiliation) Date Time <br /> Report To: Bill to: ULT <br /> RAMAR INC. <br /> PO A, 44,644, ���� '" 525 West Third Street <br /> Hanford,CA 93230 <br /> 7�Z - <br /> 0-7 Attention: — Aegmmg-a' ' w,.,, 0• <br /> WHITE: Return to Client with Report YELLOW:Laboratory Copy PINK:Originator Copy <br />