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Ultramar Inc. 3BEACON <br /> CHAIN OF CUSTODY REPORT <br /> ishisnar <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> ANALYSES of <br /> Project No. Sampler(Signature) n/P n C <br /> Project Location Affiliation <br /> 6 <br /> tv b/ <br /> Sample No./identification Date Time Lab No. m I zi REMARKS <br /> W - 3 <br /> I 6n <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: Date Time <br /> /e1i <br /> -R—elinqbi'shed by: (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Relinquished by: (Signature/Affiliation) Date Time (Signature/Affiliation) Date Time <br /> L L6N <br /> Repo.rt To: Bi to: ULTRAMAFA INC. <br /> 525 West Third Street <br /> Hanford,-CA 93230 <br /> Attention: <br /> 32-8003 IM <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy <br />