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i <br /> Ultramar Inc. BEACON <br /> ' CHAIN OF CUSTODY REPORT <br /> uman,ar <br /> Beacon Station No Sampler(ZNamr'7naForm No of <br /> CP jl9 <br /> Project No Sample nate ) <br /> o a <br /> Project Location Affdiat� 5 -- <br /> o C <br /> g*Do� u rt zdA� 5UV1rVAArAJd <br /> w = = <br /> Sample No/Identification Date Time Lab No � a � z° REMARKS <br /> w - oar - ��`l �� Nw <br /> Relinq Lby <br /> Sign ture/Affiliation) y <br /> ate ITIme Received by (Signature/Affiliation) Date Time <br /> 0 r + <br /> Relinquished Signature/Affdkation) Date Time Received by (Signature/Affi4ati Date Time <br /> —F <br /> elinquished by (S�gnature/Affiliation) Date Time Received by (Signatu ffdi n) <br /> / 3J <br /> Report To J Bill to ULT A AR INC <br /> a V� <br /> 52�b�West Third Street <br /> q Hanford, CA 93230 <br /> 1�6 a r7� Attention N <br /> F �NHIT turn to Client with Report YELLOW Laboratory Copy qWINK Originator Copy --a0� <br />