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0 01 - <br /> Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT _ <br /> is <br /> Beacon Station No Sa!T� (Print Name Date Form No <br /> e�s S VV►►a.M'K01- a•'G-+t rR ANALYSES Of <br /> Project No Sam r S�gr�atu�e) r, �'e4., <br /> 6 b-77 > <br /> Project Location Affiliation <br /> qOU S' c,- ,ero kee 0 0 o <br /> T1-4n t14 S0 xU <br /> Wo <br /> LU 20 <br /> 2 <br /> Sample No/Identification Date Time Lab No m a z°I REMARKS <br /> W - ( /I- S-"4-52� "17 �x i <br /> ? Z- i 12, 00 <br /> Z i , C �( <br /> ziNA <br /> AA w• z3 o: 3 3xx <br /> -140 i !o' S-7 <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> E�k�-A. nf oi /Oe[ <br /> 305 <br /> quis ed by (Signal r Affiliation) Date Time eceiv by (Sig ature/Affiliation) V� Drate Time <br /> f <br /> -Relinquished (Sig tore/Affiliation) Date Time R eived by /Sig6atur ffil tion4 Date Time <br /> Y �tl Il <br /> Rep&t ToR 4 rc.� atnc f�� Bill to ULTRAMAR INC <br /> be t� �Mv�rc�. m�,�rf�+t �okr� 1 fawn! 525 West Third Street <br /> Hanford, CA 93230 <br /> C R l6) 61 y z o $ r" Attention <br /> q J b 6 r <br /> /IVHITE Return to Client with Report YELLOW Laboratory Copy �IK O�inator C� X003 90 <br /> ,. ,�� o <br />