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Mi, - Ultragar Inc. is - - <br /> um�r�r <br /> CHAIN OF CUSTODY REPORT BEACON <br /> Beacon Station No / Sampler(Print Name) Date Form No <br /> C'y-- ANALYSES tv <br /> Project No Sampler( ignature) <br /> Project Location Affiliation -- <br /> O <br /> X "`" c <br /> W22 <br /> am le Noildent�frcation Date Time Lab Na m a a z° REMARKS <br /> (:� & -1,31S- <br /> I IA,ld <br /> - Ick -13 <br /> C - -1 <br /> Ita X/ <br /> -l3 _yj_ / <br /> Relinquished by (Signatu Affiliation) Date Time Received by ture/Affdia Date Time <br /> Relmqu (S gtur Af Date Tfime Rec 09 kKi6fieWliiaatio ate ime <br /> Rehnqu b (Signa ure/ ) Date Time Received by (SI ration) I Date J Time <br /> Report To <br /> 6 !0,/- �G,PL r to ULTRAMAR INC <br /> y, 525 West Third Street <br /> I" Gw Hanford, CA 9 230 <br /> j Attention IS -t✓sv .r/N,S r <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy u�3 <br />