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ultra&r Inc. • <br /> BEAN <br /> ! CHAIN OF CUSTODY REPORT <br /> Ultramar <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> ANALYSES of <br /> Project No. Sampler(Signature <br /> Project Location E ��„c�,- iliatidn` I N CD o <br /> CD0 <br /> UJ <br /> Sample No./Identification Time Lab No. m a Z REMARKS <br /> i� <br /> i <br /> y VJ.0 <br /> date <br /> i <br /> I L-11 1-2a <br /> Relinquished? (Signature/Affiliation Date Time Receiv by ( ig at F07AM n) Date Time <br /> Relid is by. u n Date , ime Rec iv ( t re Affiliation Da Time <br /> 7)11/W <br /> (N Iwo Date Time Received by: (Signal Time <br /> rs � <br /> Report To: J Bill to: uV RAM R INC. <br /> 525 West Third Street <br /> Hanford, CA 93234 J _ <br /> Attention: <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 32.OW3"90 <br />