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�- Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> llllraen�r � <br /> I <br /> Beacon Station No Sampler(Print Name) Dae Form No <br /> qqL� a��A � /� ` ANALYSES ZG of <br /> Project No Sampler(Signature) (� v1 <br /> q q tl <br /> m <br /> Project Location Affiliation o c 4 jra <br /> �[a- <br /> U3 0 rzo <br /> xg � q7 <br /> BaSam le Nolldentification Date Time Lab No m REMARKS <br /> -a Salo- mow - s <br /> W-os��-� �- 2 S � u� ; ,r" <br /> •+u-05 -/v) <br /> V]-0s; r0 ' 33 <br /> Relinquis by (Signature/Affil tion) Dnfa Time Rec ig re/Affiliation) X <br /> Time <br /> 1,-.0JAI <br /> Rein h (Si aturelAffiliation) Dat Time Received by (SlgnaturelAffiliation) Date Time <br /> S <br /> Relinquished by (Signature/Affiliation) Date Time Received by (S�n ffi� do D e Time <br /> Report Toi i to ULTRAMAR INC <br /> a <br /> � ry <br /> 2 G r����� � 525 West Third Stree <br /> I, Hanford, CA 93230/�"Attention ' <br /> WH Return to Client with Report YELLOW Laboratory CopyPINK Onginator Copy � <br />