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Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> dtioranw <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> ANALYSES j- •� 1 of.2— <br /> h la I y' ,,< <br /> Project No Sampler(Signature) <br /> 9�• ts � 5 -01 <br /> Project Location Affiliation �, <br /> 1)C) eke)5 Ghiy /� /J p 0 �T <br /> L ,4,'V LLC fjr- X <br /> W Z ZCL O <br /> Sample Noildentification Date Time Lab No m z REMARKS <br /> W- �. 6 0 n 3 -540-6o042- <br /> W-/ 7 <br /> 5 }03o042- <br /> w-/ 7 c� <br /> 040 <br /> 114- 5 f oil <br /> IJ9 <br /> Relinquished by (Signature/Affiliation) Date Time R�k44T/ey (Signature) ffdiait Date Time <br /> 3 �3. 1,5 3 <br /> qw ed by (Signature/ filiation) Date Time ` ice veil by Egnature/Affiha on 3 J D��t Time <br /> aQs LS�'l�l/0r z G / � ' �/e� �"'T <br /> inquish y (Signatu a/Affiliation) Dae Time Received by (Signature/Affiliation) Date Time <br /> Report To _ ./I ���� Bill to ULTnAMAR INC <br /> RI-M-��� ` J "' 525 West Third Street <br /> Hanford, CA 93230 <br /> Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 329003A0 <br />