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Ultramar Inc® BEACON <br /> CHAIN OF CUSTODY REPORT <br /> U1tr�rrar <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> ��, I� Sq'i 6 p ANALYSES a-of 3 ' <br /> Project No Sampler(Signature) <br /> Project Location Affiliation �, 2 <br /> C <br /> r <br /> o <br /> �. <br /> wWo <br /> LU ° <br /> Sample NoAdentification Date Time Lab No m a. z0 REMARKS <br /> 7-C, 73 ~ a9 Wr kJ <br /> �1 sol <br /> m w-).7 7 0 - 13 <br /> ,MW`�� <br /> M W'). 71$ <br /> MVV- 30 73.5 <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) qat! Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Report To_ Bill to ULTRAMARVW <br /> /1 �-CII 525 West Third Street <br /> Hanford, CA 93Q <br /> Attention ., <br /> WHO Return to Client with Report YELLOW Laboratory Copy* PINK Originator Copy '"° <br />