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Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> R7 <br /> Beacon Station No Sa lG Qer Print Name a Form No <br /> ANALYSES `l' 9 of <br /> r^o� O NSOn, <br /> Project No Sa (I atur ) <br /> e <br /> Protect Location Affiliation <br /> �rr w ,) <br /> K 4eu tl`l Z:0 .1 1�111►�Ji[7,�1� 1 x 2' v �'L <br /> wxz ° <br /> Sample NoIldentification Date Time Lab No m z°i REMARKS <br /> - ©y0ly- FF �-�1 Q5 f��(D rfi <br /> 3 <br /> Re i h by ignature/Affiliation) Date Time Rec ved by (Signature/Affiliation Date Time <br /> q-q yid - /1(30 <br /> Rel, uished by (Signature/Affilial n) Date Time Received b Signature/Affiliation) Date Time <br /> Relinquished b ( ig ature/Affiltati n) Date Time Receiv b (Signat r Affiliation) Date Time <br /> bk f ,yam <br /> Report To 1. Bill to ULTRAMA INC <br /> �UN�tiPt/' 525 West Third Street <br /> CN) <br /> t 37^ 2 70 AttentionHanford, CA 93230� _ k�4��}t- <br /> �3 a -- <br /> r WHITSeturn to Client with Report YELLOW Laboratory Copy PINK Originator Copy 12 B <br /> y Tr y <br />