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' 4 Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT' <br /> Beacon Station No. Sampler(Print Name) to Form No. <br /> �. 3 U z ANALYSES � / Z of .3`r <br /> Project No. Sampler(Signature <br /> 12norntul 7'�} <br /> Project Location Affiliation c = caJ N Q <br /> ca-,gdj 06. <br /> 171, G) w 0 11 <br /> was <br /> = z o <br /> Sale Noildentificalion Date Time Lab No. m z <br /> SawREMARKS <br /> -� - o s ` <br /> a�. 7 <br /> a <br /> -1- <br /> T � <br /> .51 <br /> 0 LIZI <br /> Relinquished b : (Signature/Affiliation) D to Time Received by. (Signature/Affili lion) Dale Time <br /> elinquishe by:(81gnalurelAffil'alion) Dale Time Receive by: (SignalurelAflihation) Date Time <br /> -/cr 7�akw, <br /> Heliprquish d by: (Signalu�elAilili tion) Date Time Received y (SignaMrelAffilialion) Dale Time <br /> Repot T : I Bill o ,: ' UL AMAR INC. <br /> ry(' 525 West Third Street <br /> t C 6,11C.I/C t/' Hanford. CA 93230 <br /> f <br /> Attention: -e v7 n Cf tiuY r s'f <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 32-8003 I'°° <br />