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unrasr Inc. BEAC N <br /> J- CHAIN OF CUSTODY REPORT <br /> uhamar <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> ANALYSES ""` of <br /> Project No. Sampler(Signature). <br /> c <br /> -r c <br /> Project Location Affiliation N N o <br /> w T 2 O <br /> Sample NaJldentilication <br /> Date Time Lab No. m a z° REMARKS <br /> I x <br /> di <br /> r <br /> I <br /> Date Time Received b S' nature/Affiliation Date Time <br /> Relinquished by: (SignaturelAffiliation) Y� ( �9 ) <br /> Relinquished by: (Signature/Affiliation) Date Time Receied by: (Sig ture/Affiliation) Date Time <br /> a <br /> Reiinqu hed by: (Si afore/Aiiiliation) Date Time Received by: (Signature/Affiliation) Date e <br /> I <br /> f I Bill to: ULTRAMAR INC. <br /> Report To: 525 West Third Stre <br /> Hanford, CA 93230 _ 1 <br /> Attention: <br /> PINK: Ori inator Co 32-80037190 <br /> WHITE: Return to Client with Report YELLOW: Laboratory Gopy 9PY <br />