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ILImra ar Inc. BEAC©N <br /> CHAIN OF CUSTODY REPORT <br /> UNr.nar <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> ANALYSES of <br /> Project No. Sampler(Signature) <br /> To97 <br /> Project Location <br /> Affiliation c 4) <br /> m N o <br /> W{ a <br /> w ,== o <br /> m <br /> Sample NoAdentification Date Time Lab No. z REMARKS <br /> M W -2-3 Al <br /> M W-:� 3,j" oa <br /> 116 <br /> M VV 1L56 as <br /> 0710& r . <br /> Relinquished by:(Signature/Affiliation) Date Time Received by:(Signature/Aff ilif ion) Date Time <br /> Relinquish by: (SignaturelAffifiation} Date Time Rec <br /> ly:(Si ature/Affiliation) Date Time <br /> Reli wished by: ignature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> ,�c ts35 <br /> Report To: Sill to: ULTRAMAR INC. <br /> 525 West Third Stree <br /> Hanford, CA 93230 <br /> Attention: <br /> jaz-eoa3 ciao <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy <br />