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ultratar Inc. <br /> BEACON <br /> unramar <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Dtot Farm No <br /> ANALYSES /`J(v of <br /> �1 �cJF 1G�ir�,S <br /> Project No/� 1 Sam r(5ignatur ) <br /> Project Loc tion Afhlia on / <br /> �235� n,,X,e.4 X <br /> q 5�Q �7`ani��� C�ri,o� /�E»+iraL Ale,, rn�_ c_°� /J <br /> ' w22 _ � <br /> Sample NoAdentification Date Time Lab No m � z°I REMARKS <br /> 5 - �riS x :30U <br /> /,Ona oy Vi <br /> r <br /> 5 - /0)1 k' - ^ ' S 0(, <br /> -3.'00 Pr7 , I <br /> Reli shed by ignature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Reil qurshed by naturelAf aliat ) Date Time Received by (Signature/Affiliation) Dale Time <br /> �Sw A4-�Ua <br /> Relinquished by (Signature/Affiliation) Dale Time Received by (Signature/Affilialion) Date Time <br /> 5 <br /> hJ4X0-re,)6-v AveBill to ULTRAMAR INC <br /> Report To (rgy�y �3�si4r�c:� <br /> 525 West Third St t <br /> A/C� J S�G2 Hanford, <br /> CA 932,V <br /> /l�e,✓�/J� ��i'�r FNSc�I� <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 32E003 1190 <br />