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I� r Mr rrr M Ift r M_ 00 °r <br /> i <br /> Ultra ar Inc. 161d <br /> �rirr�r �� �7,0BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Sa ter(Print Na ate Form No. <br /> 4_74 ANALYSES -�—�' 7—of �- <br /> Project No. S ler ature) <br /> 14 7� ` ( 0 /G/J�r�r� <br /> Project L tionffi' nZZ <br /> r� /IBJ �' X v r <br /> O <br /> Sample Noildentification Date Time Lab No. m a z REMARKS <br /> S - (:5 - S — 2V-ff 16.,z-3 -u l t Xd4l <br /> sC) - a-5 -/(,If' js _- 1/0 <br /> i <br /> Relinq ished (Signatur filiation) Date Time Received by:(Signature/Affiliation) Date Time <br /> inqu' h #ure/Affiliati n) MaieTimelReceived :( ignature/Affiliati ) a Time <br /> Relinquished by: (Stnature/Affiliation) Date Time R eived by:(Signature/Affiliation) Date Time <br /> S , 2,0 L [ <br /> Report To I Bill ULTRAMAR <br /> Q 525 West Third Street <br /> Hanford, CA 93230 <br /> Attention: <br /> •9/ <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy 32.8003 IM <br />