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Ufframar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> unr�nw <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> r ANALYSES .917—,01 zef �- <br /> Project No �O SagmLer(Saffature) <br /> Project Location Affdiat <br /> 75 0 <br /> 40 /Q <br /> 54 dv4ft �-, C'� / o <br /> w22 0 <br /> Sa le No./Identification Date Time Lab No m � a z REMARKS <br /> S -6 - MW 6 /0/0 <br /> 5 -70 —MW S /D/� <br /> Relpquish by (Sig ure/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Relinquish ( ignature/Affiliation) D e Time4 Received by t ignature/Affiliation) 'Dalie Time <br /> Relinquished by (Signature(Affitiati n Date Time Received by (Signature/Affiliation) Date Time <br /> eport To. UBill to ULTRAMAR INC <br /> 525 West Third Street <br /> Hanford, CA 93234 <br /> A)c 916 - A3,9-7,172, Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 320003$&V <br />