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i <br /> ^� Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Dae Form No <br /> ANALYSES Zlr Gl of <br /> `�q y a k?A t vri 4,2 ke, <br /> Project No Sampler(Signature) <br /> I q q q <br /> Project Location Affiliation = <br /> V/*f L�kk L <br /> uu x M <br /> Sample NoAdentification Date Time Lab No m p-- z REMARKS <br /> Wvi- 2 1 � <br /> -,u-05 <br /> r <br /> 7-3 <br /> ReBnquis by (Signature/Affil tion) © Time Rec Sig re/Affiliation) Dai Time <br /> yam, <br /> Relliation) Dat Time Received by (Signature/Affiliation) Date Time <br /> 5 <br /> Relinquished by (Signature/Affihation) Date Time Received by (Swn ' ffihat�o D e Time <br /> Report To i I to ULTRAMAR INC <br /> a ril Ro, rlle►- (1� 525 West Third Stree <br /> Hanford, CA 93230 � �� <br /> Attention <br /> WHITEOrn to ClientwithReport YELLOW Lal3oratory Copy INK Onginator Copy 32800 <br />