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Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Pant Name) D to Form No 1 <br /> ANALYSES �i $ of <br /> Project No Sam er(Stgnat re) ! <br /> P/ro�ject Locat�o � � Affiliation Are `,/1 <br /> Zy 3 CI W)»C /� y C � L�U/trV� <br /> Jam/ CA ��� /[vii Cl) i 6-iVI KavI 1(�,+l Z )yVe. XU�1 U 1j} 0 <br /> W _ O <br /> sample No/Identification Date Time Lab No m a z° REMARKS <br /> JK <br /> s S s r )0 c�� 3c���. v� t/ 1 <br /> q0 by V <br /> "aS7 C6 <br /> -'s 5 <br /> 37"55A <br /> R uished b (Signature/Affiliation} Date a�Timeeceived by (Signature/Affiliation) Date Time <br /> 4�1 /CJ <br /> — <br /> Relinquish ignature/Affili n} Date Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Report To CArzy 2$a2,t ,,C Bill to ULTRAMARINC <br /> /��C� or� E�✓�1PEa�IE�r+L 1/vC525 West Third Street <br /> S'o11 644 `r1Hanford, CA 93 0 1 <br /> Adlik (-5,1dvJ?,aCo HELLS G� �$��„^� Attention �t��� 5�c� Y�o�JStlry <br /> VW Return to Client with Report YELLOW Laboratory Co PINK Ongrnator Copy � <br />