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r r It r r r r r r r( - r r f f t r r r - ' r <br /> Ultramar Inc. <br /> - BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Sampler(Print Name) Dale Form No. <br /> ANALY S 'z6�s Z' of <br /> Project No. Sampler(Signature <br /> Project Location Affiliation q J <br /> ° <br /> LU <br /> Sample No./Identification Date Time Lab No. z REMARKS <br /> Z3,muv <br /> m/ C�rcy f`s:od 3 <br /> W,23 iI1�J � G � 5 . vv <br /> K1, -�'Yl(�1 / Lr t�,� z-z 9 z t g :00 <br /> Relinquished y: (Si nature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> (Si <br /> � f- <br /> Telfhquighed by: (Signature/Affiliation) Date Time Rec d ignatur ffiliation) Da Time <br /> Relinquished by: (Signature/Affiliation) Date Time eceived by: ( ignature/Affiliation) bate Time <br /> Report To: Bill to: ULTRAMAR INC. <br /> Ply 525 West Third Street <br /> Hanford, CA 93230 <br /> Attention-.- .- <br /> 3zeoo„ <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy � <br />