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Ultramar Inc. <br /> BEACON <br /> CHAIN OF CUSTODY REPORT <br /> unranw <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> S J <br /> ANALYSES /--46-q b / of / <br /> 3 /��� s p-� <br /> Project No. Sampler(Signature) <br /> a) C 7-A T <br /> Project Location Affiliation G cc <br /> 75 Q <br /> H N C <br /> p y O <br /> w =2 0 <br /> Sample NoAdentification Date Time Lab No. m z° REMARKS <br /> GN- 5.0 3�. ?/- <br /> 0/- <br /> 1--1 1 113 .0 faZ <br /> 41 VV-3 r/ r � <br /> /0 <br /> _ r , <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: <br /> ,(Signature/Affiliation) Date Time \ <br /> V'A6 A-Wo <br /> Relinquished by:(Signature/Affiliation) Date Time Received by: (Signature(Affiliation) Date Time <br /> Relinquished by: (Signature/Affiliation) Date Time Rece' by: (Sign re/Affiliation) Date Time <br /> WL--s- T lsSwo <br /> �,..� LO <br /> Repo To: Bill to: ULTRAMAR INC <br /> ,OL� ,�,,,,J 525 West Third S t <br /> Hanford, CA 93230 <br /> Attention: <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 32-do03 IW <br />