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dunnwnar <br /> Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> �- ANALYSES of ( n <br /> Project No Sampler(Signature) <br /> lel CM r/ 1 1 <br /> r � ���_ 41 'Ates -w- <br /> Project Location Affiliation C <br /> o m c <br /> r r H O <br /> Lu _= O <br /> Sample Noildentification Date Time Lab No ao � zREMARKS <br /> V i <br /> ' rVC1 <br /> I <br /> Relinquished by (SRgnaturp/Affiliation) Date Time Received b i k1ure/Affilia ion ,J Y �� ! ) �� Date Time <br /> Zc-1 J <br /> Relinquished b (Signature/Affiliation) Date Mme Received by (Pigri turelAffdiation) Dale Time <br /> Relinquished b . (Signaiurel ffdia son) Date Time Received by (Signatur raf-ion) Dale Time <br /> Repo o r- a ULTRAMAR INC <br /> 525 West Third Street <br /> Hanford, CA 93230 - <br /> Attention —K r�-v e)`f o A., <br /> WHITE Return to Client with Report YE=LLOW Laboratory Copy PINK Orminator Cor)v 3280031&10 <br />