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UltramarInc.IBEACON <br /> PLtsimm <br /> ('Jito) l`7? �70[) <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> 9 ANALYSES of <br /> Project No Sampler(Si ure) <br /> Project Locationl E. F� �o,�r A cation "� 1CI" <br /> CA A— 0 a <br /> 0 <br /> Sam le Noildentification Date Time Lab No m� � z°i REMARKS <br /> �►� - I �!�s� 9 IX I <br /> 1 <br /> - 3 <br /> M uU - b W 4 x =' <br /> Relinquished bignature/Aff}}ration) Dte Time Received n ur y n Dale Time <br /> Relinqu by (Signatu elAtliliation) Dale Tune Re i ig ature" fid ion) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Street <br /> (•'SU IYICLC,'1 >y LA), 4-16 ) f AX 7f,,-7f~ ;C, Hanford, CA 93230 <br /> nn1Attention <br /> I�LtSL V 1 t_L.e , 6i9 . f-5 c`�7e, <br /> WH1TIReturn to Client with Report YELLOW Laboratory Copy • PINK Originator Copy 320 <br />