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Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> l�nrarnar � <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> 6 i,( ANALYSES of <br /> Protect No Sa ler(Si ature <br /> l & ql l M <br /> Protect Location Affiliation <br /> � <br /> o <br /> 4 G rt1 •�/ �� � z O .V rn� _ <br /> UJ <br /> 14- <br /> Sample Noildentification Date Time Lab No m r z° REMARKS <br /> - �� - T, It/,360 -of J <br /> _ SIL <br /> 3 1 <br /> 5 - <br /> o <br /> - I e os <br /> I'- - � �i oro � <br /> Ml - <br /> e <br /> a/Affiliation) IlDate Time Received by (Signature/Affiliation) Date Time <br /> Relmquis by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br />� 1 t l30 <br /> Report To Bili to ULTRAMAR I <br /> Cr i clr / 525 West Thi Str t <br /> / G Hanford, CA 93 <br /> Ho <br /> c <br /> 'v Attention ✓ y <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 3280031190 <br />