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I <br /> Ultramar Inc. BEACON <br /> CMN OF CUSTODY REPORT f <br /> _Ultramar <br /> Seaconfttlon No Beacon 695 Sampler Ott Nem) ANALYSES Rata Form No <br /> Hal 6 -/q �3 1 �A— <br /> Protect No 94--695-01 Sampler( �—d ' <br /> Tri <br /> Poled Location Affiliation Doulos Environmental a <br /> Lodi, Ca U <br /> Sample NoAderibficatron Oats Time Lab No m � � � REMARKS <br /> NW-1 _ ,v 6-1-512179-01 �[ <br /> Mw-e 12179-02 a <br /> MW-16 3 rt� 12179-03 <br /> MW-17 ��Q ' 12179-04 T 1 <br /> MW-1B 12179-05 <br /> MW-20 12179-06 a <br /> • Mw-21 So D 12179-07 .� <br /> JI! <br /> Relinquished by(SignaturelAffiliation) Date Time Received by (Slgnature/Af5llabon) Dste Time <br /> Relinquished bylSlgnature►/Aft'illatron) Date Time Received by (S1gnature/Affllatron Date Time <br /> Relinquished by(Sign Affrlmtlon) Date Time Received by (Signature! do 6D961Time <br /> 0/p <br /> Report To Sheila Richgets Bill To Ultza <br /> Fugro West, Inc. 525 W 3rd Street <br /> 1050 Melody Lane, Suite 160 Hanford, CA 93230 <br /> Roseville, CA 95678 Attention Kenneth Earnest <br />