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U40nar Inc. a� BEGON u, . <br /> CHAIN OF CUSTODY REPORT �— <br /> Beacon Station No. Sampler(Print Name) Dat Form No <br /> ANALYSES t of <br /> Project No Sample S at re} i v C <br /> Project Location Aff fiat n - h <br /> t !� �D a GO f 4ft �- <br /> a <br /> i ] <br /> Sa le NoAdentifiication Date Time Laz REMARKS <br /> ' = <br /> d4 jv <br /> i <br /> • o� - 03 <br /> w r Y9 rbc <br /> / � 1 <br /> -o7 <br /> tk/- -o <br /> Relinqued y s Affiliation) Date Time Received by (Signature/ diation) Date Time <br /> Ano��� <br /> R y (Signature/Affiliation) Date Time Received by (Signature/Affdiation) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) _ Date Time <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Street <br /> Hanford,CA 93230 U� <br /> �. 2 �� �, Attention G r61 <br /> y <br /> WHITE. Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy <br />