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mar Inc. *CON <br /> CHAIN OF-CUSTODY REPORT <br /> ullnMn■r f <br /> 3 <br /> Beacon Station No Sampler(Print Name) l Date �. Form No <br /> ' ANALYSES fi� `� a_ of) <br /> /� r <br /> Protect No Sampler(Signature) � <br /> 16 <br /> Project Location Affiliation E (U <br /> LU _ = c o <br /> Sample No/Identification Date Time Lab No m H z° REMARKS <br /> Al iris k If I L1� L I I1 <br /> Relinquished by ,Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> e inquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Street <br /> Hanford, CA 93230 <br /> Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 32 <br /> '007 A0 <br />