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Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Statoan No Sampler(Pant Name) patQ Form No <br /> L40M ROD Cdo55 ANALYSES I--)h MA of <br /> Rrolici ND Sampler( nature <br /> 1`��5 t a <br /> to <br /> Project Lacabon 'Zl`3 5 F. f��,.r � Affiliation <br /> w <br /> Sample NoAdentincadon Date Time Lab No T REMARKS <br /> r \\4-S a110�iw og Zo 3 ,4 vaas i"S . <br /> R CEIVED <br /> TE °TIP&= of <br /> INl )A_ <br /> EST LAB <br /> Relinquished by ignaturelAtfilration) Date Time ReceEv ( refftl n Date Time <br /> //,"��4 /A>/, <br /> Relinquis (Signature/Afft Date Time Fier iv <br /> by A i is io 770ate <br /> Time <br /> Re is nater p ere <br /> y (Signature/Affiliation) Tsrne <br /> Re rt To I dP <br /> Po ��r.r� —(�„� r��� o ULTRAMAR INC <br /> 525 West Third Street <br /> Acv J �N L Hanford,CA 93230 <br /> Attention _ _ K <br /> WHITE Return 10 Client with Report YELLOW Laboratory Copy PINK Originator Copy 324M3„b <br />