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0 i ! <br /> Ultramar Inc. BEACON - <br /> CHAIN OF CUSTODY REPORT <br /> tiieramar <br /> Beacon Station No Sampler(Print Name Date f=orm No <br /> /_ q ( � k /��` ANALYSES 'Zx — of <br /> Project No (� Sampl (Signature) liC <br /> Project Location Affdiatian S a U `� <br /> o —� <br /> w = 2 0 <br /> Sample NoAdentlfication Date Time Lab No Coa a z REMARKS <br /> Reli fished by (Si natur ffiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> I <br /> Relinquish y (Signature/ f ihation) Date f <br /> e Recei by ign ure/Aftiliation) Date Time <br /> Reli fished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Report To Bill to ULTRAMAR INC <br /> &V f t{ r/��r 525 West Third Street <br /> Hanford, CA 932 mac, <br /> Attention l I e .IV <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy <br />