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r r M M MM M mom M r M M M r <br /> Ultramar Inc. BEACON <br /> i CHAIN OF CUSTODY REPORT <br /> Uma�nar � <br /> Beacon Station No Sampler(Print Name) D to Form No <br /> 6K /(?-/,/: ���.�w �,.` ANALYSE=S 2�� 5 4 S of � <br /> J <br /> Protect No Sampl ( ignat r <br /> 4a ' q1. fn <br /> Cu <br /> Q) G <br /> Project Local nL� �r4 A ihationL11 <br /> .S <br /> N o <br /> � QCf+` �t(i. �V�✓.rthca{R 1 ULC�1lc...h" lkti O»_ V_ <br /> W 12 <br /> Sample No/identification Date Time Lab No m z REMARKS <br /> 5'o - T - a z�3f�Q /r 41 I �.Ie <br /> IL 3 <br /> ;Relinqgish by (Signal /Allilia on) Dale Time Recc wed by (Signatu /Affiliation) Date Time <br /> 537 /J�Ar � <br /> R linquished by (S lure/Affiliation) ale Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Sig nature/Affilialion) Dale Time Received by ¢alar ffilia ion) I D e Time <br /> Report To Bill to UL RAM INC 525 West Third Street <br /> t v �••��-� Hanford, CA 93230 <br /> 333o /ov Mention . {C ��✓•. <br /> 1&-tl- Cor. ✓G CA M16 <br /> 0 to !� (-'r it n i ,err I fllhf I I ` "�� fll�llf n -,l�, (`fl f, J2 Bn01 rA7 <br />