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ultramar lint. BEACON <br /> CHAIN OF CUSTODY REPORT ` I <br /> tt�lnmar `') <br /> Beacon Station No. Sampler(Print Name) Pate Form No. <br /> J\ e— r� ANALYSES O 1, of <br /> Project No. 1 Sa tier S/ig ture) <br /> Projectcation Affiliation �, <br /> f 1av� a ch� ,: <br /> I� X 1_i o <br /> Sam le No./Identification Date Time Lab No. m z° REMARKS <br /> M W �`A 10 '-o -C'1 TAT <br /> Re)i is by:(Signature/Affiliation) Date Time Received by:(Signature/Affiliation) Date Time <br /> �,�.�!/ J,�S ��ssecici � I`�-� �► i t%F �'Z � �`f�,� <br /> Relinquished by:(Signature/Affiliation) Date Time Received by:(Signature/Affillation) Date Time <br /> Relinquished by:(Signature/Affiliation) Date Time Received by:(Signature/Affiliation) Date Time <br /> Report.To: Bill to: ULTRAMAR INC. <br /> �S _ 4 '45,CCc 16� 525 West Third Street <br /> 3 IAD "o k C6"y k Hanford,CCQ3230 oFlo Cf 05610 Attention: _c;e— Wrdne <br /> v <br /> WHITE:Return to Client with Report YELLOW:Laboratory Copy PINK:Originator Copy 32-SM IM <br />