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r r i r r k r t r r r� r r i r [ r r ' r ' ' r <br /> Ultramar Inc. <br /> BEACuN <br /> CHAIN OF CUSTODY REPORT <br /> utlran�r <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> ANALYSES of <br /> Project No. Sampler(Signature) F <br /> sc' ( 02_ -03 <br /> Project Location Affiliation E- <br /> w =M <br /> Sample No./Identification Date Time Lab No. m F-- z° REMARKS <br /> z-x-17 z rs. 45 <br /> W, -rn w 3 � r, �;�� <br /> 1AJ Z <br /> W 23 Atj 2 LcT� <br /> �,�/-23 fViv�12 Lcr��e 7/14 �1L Itl "l <br /> Relinquished by:(Si nature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> ti /Pe.a 2,2�,4z $''t S r _ - Z..- <br /> Relinquished by: (Signature/Affiliation) Date Time eived y: (Signa a/Affiliation) a Time <br /> Relinquished by: (Signature/Affiliation) Date Time Received b((SignaturelAffiliation) D to Time <br /> Report To: Bill to: ULTRAMAR INC. <br /> 525 West Third Street <br /> Hanford, CA 93230 <br /> Attention,.----.--- <br /> WHITE: <br /> ttention:WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy J2-90031M <br />