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Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT /I <br /> utnrrnar <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> `7 7 l �/% / C9�5-�/1 ANALYSES -/D '9 of <br /> Project No. Sampler(Signature) y <br /> Project Location Affiliationa. <br /> � 2 2 rZ1 <br /> Sam le No./identification Date Time Lab No. � REMARKS <br /> 01 <br /> -:5 3/0 <br /> -d <br /> 7 1610 <br /> Relinquished by: (Sign aturelAffiliation) Date Time Received by:(Signature/Affiliation) Date Time <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: (Sig nature/Afliliation) Date Time <br /> Relinquished by: (Signature/Affiliation) Date Time Regeived by: ( ' nature/Afliiiation) D to Time <br /> 9� C73� <br /> Report To: ill to: ULTRAMAR INC. <br /> 525 West Third Street <br /> Hanford, CA 93230 <br /> Attention: <br /> j WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 32,6003 IM <br />