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Ultramar Inc. P 07 7 ° BEACON <br /> CHAIN OF CUSTODY REPORT <br /> tater <br /> Beacon Station No. Samp r(Print Nam Date Farm No. <br /> ANALYSES f// — of -� <br /> Project No. Sam ler(Si ure) <br /> Project Locatio i <br /> r <br /> TMV o I <br /> OF WZ2 <br /> Sample NoAdentification Date Time Lab No. m I z°I REMARKS <br /> ISL _ _ -17 <br /> Reli uish y: (Sig ure/Affilia'on) Date Time Received by:(Signalure/Affiliation)% Date Time <br /> l 7A 7 51 g A1K&LtJ 0,t641 I 5 e i '3G� <br /> n ish y: ignaturer iliation)� at Time Received by:(S' ature/Affiliation) a e Time <br /> Relinquished by:(Signature/Affiliation) Date Time R pived by:(Signature/Affiliation) Date Time <br /> Reporto, Bili t ULTRAMARINC. <br /> ql_ �1��� 525 West Third Street <br /> Hanford, CA 93230 �, l <br /> 9- Attention: <br /> WHITE: Return to Client with%Report YELLOW:Laboratory Copy PINK:Originator Copy ua� � <br />