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1 Ultramar Inc. <br /> � <br /> lul <br /> BEACQNCHAIN OF CUSTODY REPORT <br /> Beacon Station No Sa ler(Print Name) Date Form No <br /> f t C �O�,�JSa1V ANALYSESof <br /> Prole No Sam S nat �e) <br /> 1�7q--3 !2 <br /> Project Location Affili tion 6 0 �? �03 E �r <br /> ��yt,j T f 2�/� �lV t1'►l�Cvtt�C�o'�-�t.f v,� � <br /> UM O <br /> Sample No./identification Date Time Lab No a. z° REMARKS <br /> Rel is b (Sig ature/Affiliation) Dat Time Received by (Signature/Affiliation) Date Time <br /> y a'�(0 <br /> Relinquished by (Signature/Affiliation) Date Time Received b S, nature/Affi ) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Sign ff,lia to Time <br /> Report To 4 � � Bill to U C <br /> 5 West Third Street <br /> p, 9 Hanford, CA 33230 t� <br /> Attention �f(:°,tom <br /> ' WHITWeturn to Client with Reporl YELLOW Laboratory Copy* PINK Originator Copy � <br />