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v1 ?:{tip <br /> Ultramar Inc. r -7 -Z 0 BEACON <br /> 1lft�r <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Sam ler(PrintN ,� Date Form No <br /> ANAL'1F$ES <br /> Project No. Sam ler(Sig <br /> �n <br /> Project Location ill do V <br /> x <br /> / 17 <br /> Sample NoAdentification Date Time Lab No. m a z REMARKS <br /> H-17-27 <br /> T- 3 <br /> 0 <br /> v <br /> = � -1 V <br /> Rel'nquis by:(Sign re/Affiliat' n) Date Time Received by:(Signature/Affilialion) Date Time <br /> Relinquiished"ignaturetAM.1i.atlofif 11afeTime Received by:(Sig lure/Affiliation) at Time <br /> Relinquished by: (Signal re/Affiliation) Date Time Receiv by: (Signalure/Affiliation) Dale Time <br /> AP[AkL.4 /�J/ iC,-,Loo <br /> Re rt To: f Bill to: LTRAMAR NO. <br /> Q � 5 5 West Third Street <br /> anford, CA 93230 <br /> 91baW— Z/7� ltention: <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy <br />