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i <br /> Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> llmarrrar <br /> Beacon Station No Sa le (Priv Na ) Qat0 Form No <br /> ANALYSES " t!7'G of <br /> [ a � VtItQ�N <br /> Protect u Samp n ure) A i <br /> N <br /> �-r E, 1V PAO <br /> Protect Location Affiliation o 1 <br /> o <br /> X rn o <br /> w = = o <br /> Sample No./ldentification Date Time Lab No m rte- z REMARKS <br /> A- 006 - IAS 1 <br /> Reh b (Sig ature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> 117 fig, <br /> Relinquished by (Signature/Affiliation) Mite Time Received by (Si nature/Afhh Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Sig a/'A illation) to Time <br /> 7/) <br /> Report To r,, � r � G/, <br /> �aV'� Bill to V~ @ �.D A A Il�lt?" <br /> / 525 West Third Street <br /> n ( U <br /> Q( :C Hanford, CA 93230 NAA)ie_� <br /> Attention N/L9E5�_ <br /> WH ITIOlurn to Client with Report YELLOW Laboratory Copy MPINK Originator Copy 32a <br />