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SM <br /> M � <br /> qr <br /> Ultramar Inc. BEACON <br /> urranrr <br /> CHAIN OF CUSTODY REPORT L� 1 <br /> Beacon Station No Sam ler(Print Name - $/) Date Form No <br /> ANALYSES 4�-/ of <br /> Project No r( iure) <br /> Project Location #filia N 7`67elk� CD 10 <br /> ! <br /> 0 <br /> Sample Noilderdification Date Time Lab No m a z REMARKS <br /> S r -, 0 9-04 I <br /> ,r 0$Z g 1 <br /> S-- �- d X39 r r <br /> 0g5 <br /> 5 —30 — <br /> p 9zL —c�3 <br /> Relinquish by (Sign re/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> � r <br /> eli wish y ignaturetAffiliation) bote Time Received by ignature/Atf kation) } e Time <br /> Relinquished by (Signature/Affiliation) Date Time eceived by (SignaturelAffiliation) Date Time <br /> VJ <br /> Report To Bil o ULTRAMAA INC <br /> 525 West Third Street <br /> y Hanford, CA 93230 <br /> .9/ — A.3 4—U 7 2- Attention r.WHITE Return to Client with Report YELLOW Laboratory Copy 32E00)IMO <br />