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Ultra&r Inc. <br /> W1ran�r <br /> CHAIN OF CUSTODY REPORT BEACtlif <br /> Beacon Station No Sampler(Pant Name) D to Form No <br /> ANALYSES of <br /> �A Jsir,4NS <br /> Project No Sam (Signature) <br /> CD <br /> Project Location EAffiliation C <br /> a sseGva1F��c.o �e.40 a <br /> N c � �J�0�2ordzl� <br /> STOCKT,v CA r'ZD� / , Gyve/!rPe,.✓ �L A/� da U <br /> w = = o <br /> Sample NoJlcfentificationDate Time Lab No m z REMARKS <br /> 5 <br /> /z)QeA4 A40 <br /> 5 rs �" 3D r�,'�s��. ✓ I os f- <br /> • s - s.6 -35 <br /> Rel uished y (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> — <br /> Relinquish (Signature/Af tion) Date Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date 1Time <br /> Report To,, ,A 5xl o r ,Q ---6 <br /> 11 Bill to ULTRAMAR INC <br /> C 14le 525 West Third Sir et <br /> SnI� C.c C�w� �xxSr7yj� KK,,, y'J 51'J-MV Hanford, CA 93230 <br /> LCL ,Qat�,c jjliLls 9:-76-�2 Attention ,—$V <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy <br />