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Utlrremer Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> user <br /> Beacon Station filo. Sampler(Print Name) ��D��� Form No. <br /> k y C1 RoD 6055 ANALYSES �r`+�Ry of <br /> Project No. Sampler <br /> ti9005 • to �► <br /> n� <br /> Project Location Affiliation <br /> cF� p <br /> S-SOWIN4 D 710-1 <br /> o: <br /> S le NoMentification Date Time Lab No. m CL REMARKS <br /> m - $ly10,4 l 2`.I o X X 3-�-ioK.9.vnpS ucQ �s <br /> Relinquished by:(Signature) tion) Date Time Received Date i Time <br /> OLOCk W a- <br /> Relinquished by;(SignaturelAffifia on Date Time Received by:(SignaturelAffNation) Date Time <br /> Relinquished by:(SignatureJAffiliation) Date Time 115ived by:(Signature/Affiliation, mate Time <br /> 1 <br /> Report To: Bill to: ULTRAMAR INC. <br /> "51M 525 West Third Street <br /> Hanford,CA 93230 <br /> A--�,J 1NC. Attention: , 'E,�4zNEsT <br /> WHITE:Return to Client with Report YELLOW:Laboratory Copy PINK:Originator Copy <br />