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! • i <br /> Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Date f=orm No <br /> t�oty PSD fa�5 ANALYSES 1 of <br /> Projekt Na Sampler(St a re) <br /> iv <br /> Protect LocationE.�� S . Affiliation o -- c <br /> w <br /> ua i zCL <br /> -pie No/identification Date Time Lab No M F '0 REMARKS <br /> rnw- � 4�Zt.19S o� y� Xx 3 y���� pc�Q'Ph�bi <br /> FLE <br /> CEIVED <br /> DATE I IME l <br /> INITIAL <br /> WEST. LAB <br /> 1 <br /> ReEinquished by (S nature/Atfrfliatron) Date T1me Rete ( n re/A �at�o Dat Time <br /> RelSig BateI'lline Rbce-wegYy igna ure/Affitsation at ime <br /> I <br /> el h { '9n ) ate 'me <br /> R eived by (Sgnature/Affibatio ate Time <br /> '1 <br /> _ <br /> Deport To Bili to LILTRAMAR INC <br /> • r�" t`'''� ONO 525 West Third Street <br /> Hanford,CA 93230 <br /> Attention ,ortti,��.S� <br /> WHITE Return to Chernt with Report YELLOW Laboratory Copy PINK Originator Copy V4=1GG <br />