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i, 1lnramar Inc. BEAC'N <br /> CHAIN OF CUSTODY REPORT <br /> umramar <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> 7 A/ ANALYSES -1-0'� of <br /> �n� � <br /> Project No. Sampler(Signature) <br /> Project Location Affiliation = <br /> o <br /> m o <br /> wsz - ° <br /> Sam le NoAdentification Dale Time Lab No. m ` z° REMARKS <br /> I I 1-O-C/6 115-L <br /> �C <br /> Iii �N~ 2-OR- <br /> Al <br /> -ORAl <br /> MV-1 <br /> s a -/S <br /> 0 <br /> Relinquished by: (Signature/Affiliation) Date Time IR �iv4((S' � el.Aiff Date Time <br /> Jin,,uighed by: i ature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Relinquished y: (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Report To: Sill to: ULTRAMAR INC. <br /> 525 West Third St et <br /> Hanford, CA 93230 <br /> Attention: <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 72.80niM <br />