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Ifs _ Ifs ISM M M M 1• � ir <br /> Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT /&: 2 <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> wl ANALYSES > of " <br /> Prolect No. Sampler ure) <br /> /�s//•/moi C <br /> Project Location pAMiation - 4) <br /> / 4 c <br /> 0 <br /> Sam le NoAdent:ficat+on Date Time Lab No m � o. z° REMARKS <br /> 1 1, 41 <br /> -/c�.��l�r/3 v•ice � �'.� <br /> Al- O f r/1(9/ /v z )p 3o <br /> /dvL -Alx, k-1-)Zz-0 <br /> Relinquish yr(Signature/Affdiation) Date Time Received (Signature/ illation) Date Time <br /> 7,.o <br /> e uished ignatu iI ion) Date Tim ece ed b Ig turelAffdiation) Date Time <br /> -11� W �-f <br /> L::� mquis y ign ture/Affiha a e Time 7 by 6r nature/Affiliation) Date Time <br /> r°1� 4� r �> > C <br /> sport To Bill ULTRAMAO INC <br /> 525 West Third Street <br /> /'� Hanford, CA 9320/ <br /> 1< Attention <br /> WHITE Return to Client with Report YFLI OW Laboratory Copy PINK Ongrnalor Copy 325007/0 <br />