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0 is <br /> dufframw <br /> Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> )/gfy ANALYSES ( of <br /> Project No Sampler(S gnature) <br /> Id`l'y, <br /> Project Location Affiliation = <br /> a N c <br /> 0 <br /> C)v x .�0 <br /> 11] 220 <br /> Sample Noildentification Date Time Lab No m H z° REMARKS <br /> - - 60 <br /> Reli quished by (Sign ture/AffdiaUon) Date Time Received by (Signat e If iation) Date Time <br /> 13610 I to fill ion — Date Time Received by (SignktuikWiliatibfir Time <br /> eli uis ed by ( i na r At lata n) Date Time Received by fiiliati Date e <br /> / <br /> Report To (:�7a tl { C[r ��_ Bill to UI_TRAMAR INC <br /> 525 West Third Street <br /> Hanford, CA 93230 <br /> Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 3200031J90 <br />