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Ultra& Inc. <br /> BEAM <br /> llnramar <br /> CHAIN OF CUSTODY REPORT N <br /> Beacon Station No Sampler(Pant Name) Dai Form No <br /> ANALYSES SAW, of d7 <br /> Project No Sampler(Signature) <br /> Project Location Affiliation215 <br /> � <br /> s ,cYoy <br /> p 4&K0z-Ruo Po a� o `m <br /> Samos /�a2l�J ovvl�v�6��oZ //UG c a IRA /OrPOV1LP <br /> -� <br /> W _= o <br /> E CL Sample NoAdentification Date Time Lab No m z REMARKS <br /> S _ s� _ SD �1''�G•or►', � <br /> '� � 1 �. � ��2,�J .•� cam�tr�T� Af 1 <br /> VIEST LAB <br /> 1mquished by (Signature/AIliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Re+nquis (Signatur ffll n) Date Time Received by (Signature/Affiliation) Date Time <br /> S,OdAckderm A /`l6 <br /> Relinquished by (Signal u re/Affil iation) Date Time Received by (Signature/Affiliation) Date Time <br /> lk lq(< <br /> Report To C47y WA:t� Bill to ULTRAMAR INC � � <br /> f,IcV 0,,j Cjv),<or,M&V-A1_ J4k'- <br /> .sail SC <br /> C-'JW," rTtlm - f,�a�c'"yS1 ,7 West Third� Ha Hanford, CA 93230 <br /> �4 'aQlw �1�-4s) C4 Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 3280031M <br />