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r r r r - r r t r r ( r r r r r r r r r <br /> Ultramar Inc. BEACLd <br /> CHAIN OF CUSTODY REPORT <br /> OLMranmw <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> Afvc(peti �✓ ANALYSES of <br /> Project No. Sampler(Signature) <br /> -07 <br /> ' C <br /> ffiliation <br /> Project Location <br /> a� <br /> `V 71 G,,c , S/V ch c .5 <br /> wi= <br /> Sample No./Identification Date Time Lab No. m z° REMARKS <br /> ��- <br /> Z-zr-rte -D l0 . 30 <br /> Co 4"I'00s fes' <br /> Relin uished (Si ature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> � � � <br /> Re nquished by: (Signature/Affiliation) Date Time Recei eq by;(Signature/Affiliation) Date Time <br /> 2125k 7' <br /> Relin uished by: (Signature/Affiliation) D to Time Rece d by: ( nature/Affi- n) bath Time <br /> 01 � �� <br /> s .J - <br /> Report To: Bill to: ULTRAMAR INC- <br /> 525 est Third Street <br /> Hanford, CA 93230 <br /> h �(� Attention: <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy u-8063110 <br />