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Ultra&r Inc. 13E0014 <br /> CHAIN OF CUSTODY REPORT qP1 �(o <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> l`1c J ANALYSES of <br /> Protect No W Sampler(Signaturey 5t�- <br /> Protect Localiong,,,) S C NCkU � Affiliation o , <br /> w = = <br /> Sample No/Identification Date Time Lab No m Ea � z REMARKS <br /> L: r <br /> 1011 � C ► <br /> 4 [ <br /> Relinquished by (Signature/Affiliation) Date Time Recew b (S nature/A }ation) Dpte Time <br /> . � <br /> Relinquish by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> / / c 10 <br /> Relin wished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Dale Time <br /> R ort ToL� �lL�} IZI�It�tL� 1.r1 tb)7b?Z I fCa Bill to ULTRAMAR INC <br /> 525 West Third Street <br /> 0 MCELUby Fivi lir-s(,,z W43C, Hanford, CA 93234 � <br /> Allentionlt1�t rl <br /> 1 <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy <br />