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• 0 a <br /> unramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> lilren+er <br /> Beacon Station No Sampler(Pant Name) Date Form No <br /> ANALYSES <' ' ' of <br /> Project No Sampler(Signature) <br /> , <br /> q � <br /> Affiliation cc <br /> Project Location - � <br /> o <br /> x 2 2 <br /> CL <br /> Sample Noildentification Date Time Lab No m � z° REMARKS <br /> f <br /> t <br /> 03 <br /> o5/ <br /> Cq <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Receiv by (Signatur Affihat+on) Date Time <br /> Relin fished by ( nature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Str t <br /> Hanford, CA 93230 <br /> Attention ' <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy <br />