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0 0 ' ye <br /> Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Umarnar <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> g �, 'SA414 ►+C�. �'di 0rcch ANALYSES ' Z <br /> _of ' <br /> J <br /> Protect No Sampl (S,gnaturrer) RefA G <br /> ° (D diem ok 1'� C Iq <br /> Protect Location Affi iatton �S(Q) 6 3 r o-77 -r <br /> CAeeuke. 64 N V o <br /> °M U <br /> L�<�.� 8a '0-t / X o <br /> W = = <br /> Sample NoAdentiflcation Date Time Lab No m � H z° REMARKS <br /> KI z <br /> MA W-12i ' s� sC <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/ ffiliation) Date Time <br /> -e 19 1 VJ- &9-0�r�u <br /> nqu shed by (Signature/Affiliation) Date Timejfl Received by (Signature/Affiliation) Date Time <br /> l ` 5 <br /> -!f/'//Zv� r—k <br /> Relinquished y (Si ature/Affiliation) Date Time R slued by i atur A iliation) Date Time <br /> Report To �Y� Kd e, Bill to LILTRAMAR INC <br /> U���� _KU r 4 N W e^+6 t C0_s„t+ate{, 525 West Third Street <br /> C�L i bl 61 a -Z Y0 2 Hanford, CA 93230 <br /> 63 S :? I TS Attention <br /> �IHITE Return to Client with Report YELLOW Laboratory Copy ',�4JVKinato <br />