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AD- 0 <br /> Ultramar Inc. BEACON <br /> illnrarner <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name Date Form No <br /> 4 COY } k <br /> q 1 ANALYSES Y � of <br /> Project No Sampl (S nat re) <br /> CID <br /> Project Location Affiliation <br /> 75 m <br /> A- r zG x rn o <br /> 0 <br /> Sam le NoAdentification Date Time Lab No m z° REMARKS <br /> F <br /> e o� o : -P <br /> G ' ' <br /> Q <br /> I y <br /> Ztie rr <br /> Reft wished by (Signat e/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> arc z a <br /> Relinquish b (Signatur /A filiation) Date Time Receiv by (Signat a/Affillation) Date Time <br /> /WES- <br /> Relr cashed by Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Report To Bill to ULTRAMAR INC <br /> air y �r�j�� 525 West Third Street <br /> !` Hanford, CA 93230 <br /> Hof a'ZOily Attention ip'<')S D.t/ <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy <br />