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llltrati>nar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> utra�ner <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> ANALYSES % �`�%-% of_-, <br /> r <br /> Protect No Sampler(Signature) <br /> Protect Location Affiliation ` , T/ <br /> o � c <br /> v o <br /> X <br /> WMM 0 <br /> Sample Noildentification Date Time Lab No m z REMARKS <br /> a <br /> y , <br /> vo <br /> 6v <br /> Relinquished by (Signature/Affiliation) Date Time Recenred by (Signature/Affiliation) Date Time <br /> zy-96 ��:3b ,1J W E-�- 1 -7zh11 �6 <br /> Relinquished by (Signature/Affiliation) Date Time Rece ed by (Signa ure/Affdiation) Date Time <br /> (/e�� wk, iggo <br /> Relinq fished by (Sig ture/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> �1c ANO <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Stret <br /> Hanford, CA 93230 <br /> Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy INK Onginalor Copy 32W31M <br />