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Ultramar Inc. BEACON' <br /> I CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Sampler(Print Name) Date Form No.� <br /> ANALYSES 3 3 of <br /> Project No. J Sampler(Signature) L(/-es 4 <br /> CDorrnw/ 7- 7' <br /> ` Project Location Aililiation c a <br /> O <br /> N C <br /> U <br /> Ix : <br /> Z <br /> a. <br /> Sample NoAdentiiication Date Time Lab No. m tom- I I IZIREMARKS <br /> w ti <br /> 5,L3 I <br /> Relinquished by: (Signature/Alliliation) Dae Time Received by: (Sig nalu re/Affiliation) , Date Time <br /> ein wished by (Signature/Affiliatio ) D�le Time Received by (Signature/Aifdiation) Dale Time <br /> -Relinq'ui`shed' y:(Signature/Affiliation) Date <br /> Time Receive by: ot(Signature/Affili"]alliionn) Date TlmeU to <br /> V10M. <br /> 1 <br /> Report Tq. I . Bill o: U&TRAMAR INC. { <br /> Q ((JJ / II 525 West Third Street __... .. <br /> I I <br /> A. G t� u rel/rr' Hanford, CA 93230 <br /> Attention: e N ,w- <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy . PINK: Originator Copy <br />