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i uitramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> 1Jlnra�nar ° <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> ANALYSES 3 L12. 011 <br /> Protect No Sampler(Signature) <br /> Protect Location Affiliation c <br /> Sample NoAdentlficatlon Date Time Lab No m a z REMARKS <br /> i <br /> w- 1—i 4.3 95a <br /> r C-55 2— <br /> M <br /> kw - 1 5 Z, <br /> �v �. -1-0Relinquished by (Signature/Affiliation) Date Time Redei ed (Signature/Affiliate Date Time <br /> 41,ed -e' " t-6-, '1" , JJ19� <br /> tLec'd '5ediyo/M-)- <br /> R i ui bi (Sig nature/Affil tation) Date Time ived by igpnature/Affili ion) Dae Time <br /> �Onquishepy (Signal a/Affiliation) Me Time Received by (Signature/Affiliation) Date Time <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Street <br /> /—fit Hanford, CA 9323 <br /> Attention _WHITE Return Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 32 SM140 <br />