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Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> �nnarnar <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> IN11 DU��h� � ir���a� ANALYSES � 6 of <br /> Protect No ll 11 Sampler(Signature) C� <br /> Mr-f' 4(R Sampler � f <br /> a� c <br /> Project Location Affiliation CU M LD�t <br /> � Q°i � <br /> w == ° <br /> Sample Noildentification Date Time Lab No m z° REMARKS <br /> w-o 0 - n w- 1 v <br /> t'-J - oS3 - M%w C�g lil <br /> t'J-o -3o w-3 0 <br /> 05 <br /> MT <br /> Relinquished by (Signature/Affiliation) Date Time Receiv by bn t re/Affiliallon) Dat Time <br /> Relin by (Snature/Affiliation) D Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Si Occ: <br /> Report To8111 to ULTRAMAR IN( a <br /> Golly �-q'-(�rr 525 West Thirdeet <br /> Hanford, CA 932 _ <br /> rq 1( �I� g 3q �f 7� Attention Kc�nef� C4rn tS1 <br /> W1W Return to Client with Report YELLOW Laboratory CopW PINK Onginator Copy X90 <br />