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Ultramar Inc. BEACON <br /> t CHAIN OF CUSTODY REPORT <br /> wrrarnar <br /> Beacon Station No Sampler(Pant Name) Dat Form No <br /> ANALYSES 7 /� / of / <br /> Project No Sampler ature) <br /> ✓tea <br /> � r <br /> Project Location lQ e r iliatMon N J o <br /> �c-fG�f✓ – c� w = o <br /> IL <br /> Sample No/identification Date Time Lab No m z REMARKS <br /> JCa2ur,,vt,� Gc�+a..,.rod/ <br /> -0 7zz- 'tj� J::�- 7z/—//i—Pe- <br /> er Or <br /> Relinquish (Signat Affiliation) Dat Time Received by (Signature/Affiliation) Date Time <br /> 9100 <br /> wished by (Signature/ADate Time Received by (Signature/Affiliation) Date Time <br /> I <br /> Relinquished by (Signature/Affiliation) Date Time Received by re/Affiliation) X(Da)e/ Time <br /> Report To / Bill to MAR C <br /> S7 525 West Third Street <br /> i z Hanford, CA 93230 <br /> J` <br /> Attention <br /> / [4 ,moi.1 :.;?/ 7 Xr <br /> WHITI= Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy J2 B003190 <br />