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• <br /> i Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Wlramar <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> L f <br /> 62qC2 <br /> r y & -r kr� ANALYSES .0"/ - of <br /> Protect No f Samp r[ ignature) <br /> 1 � 4 <br /> Protect Location Affiliation cc f <br /> !� v <br /> o G d v � z GLV C13a. U <br /> w == � <br /> Sample Noildentification Date Time Lab No ss. z°I REMARKS <br /> 6 f <br /> r 4A <br /> r, <br /> M2 I conjaa;c, 7-e <br /> & &24F rn <br /> a fv <br /> Reli uished by (Si Mnature/ filiation) Date Time Ryec�eived by (Si nature/Affilllication) Dy`atte�/ Time <br /> A, <br /> Gr.,ZG•v -(Il V <br /> Relinquishe^ Signature/Affili ion) Date Time Rece ed by (S ature/Affiliation) Date Time <br /> w6s r <br /> Rehnq shed by (Si aturelAffiliaiion) Date Time Received by (Signature/Affiliation) Date Time <br /> Report To Bill to ULTRAMAR INC <br /> Q r //LO k- 525 West Third Street <br /> hJ I` Hanford, CA 93230 <br /> /�0 t Z C7 Attention l �✓ G� <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy � ��8003+M <br />