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1� MMI M I MM M M M M M <br /> - Ultramar Inc. BEACCAN <br /> CHAIN OF CUSTODY REPORT <br /> un ranuw <br /> Beacon Slation No Sampler(Print Name) Dal Form No, <br /> 01r,- e-iP_w6TW ANALYSESKA tvr6wt- - , <br /> Protect No Sampler Si ature <br /> !/v`� _ <br /> Project Local�on Affiliation <br /> yLj — e-cy <br /> w _= o <br /> Sample No/Identification Date Time Lab No m � a z° REMARKS <br /> -515-I- 4- 29 14-7 xy� <br /> y X. <br /> y_ - <br /> xi <br /> Refinqu shed by (Signalur (Affiliation) D to Time Received by, (Si nal re/Alf�fiat on) Dale Time <br /> ZIA <br /> � 1 r <br /> ), <br /> e1 qui h d by ( ig at rel filia on) Date Time Recei d y; ignatu il a "} Dale Time <br /> Relin ui db �gn r / , Dale Time Red ived 'y f ign e/ lialion} D le Time <br /> , r <br /> eport Cull to LTRAMAR INC <br /> 525 West Third Street <br /> Han(ord, CA 93230 �a <br /> Attention <br /> oI n n 1 '-Irl I rWr Ilhrrr,l�r i ('nr` BINK (_)nn ,)1r)r f'oprj 3290011M <br />