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Ultramar Inc, BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Date FoNo <br /> L4 rm <br /> F-oD C-nS5 ANALYSES Zi I$As L I of l <br /> Project No Sampler(Signature) <br /> Protect Location Affiliation oct'� AT 3gr.c, <br /> LUT M: �J`�h�riAh►7 --rpT <br /> Sample No dderdifrcatron Dale TrineLab No � d a z° REMARKS <br /> zJ1s� as x x �� -roti ark, <br /> fat <br /> rnu z1 Is ��S k x 3X10 4 \J'ns Ila Ams. <br /> Rr C EIVED <br /> . tit_ <br /> Relinquished by (Signature/Affiliation) Dale Time Received by (Signalure/Atfiliation) Date Time <br /> Relinquished by (Sgnature/Atiiliatron) Date Trme Rece�v by (Signal afAffihation) Date Time <br /> Relirrq /shed by (S naturelAtfiliafron) bate--Ti-me Receive y rgnaturelAflilratron) Date Time <br /> I <br /> Report To - <br /> p° -5 .I—r�,,,IF.rw Bill to LTRAMAR NC <br /> 525 West Third Street <br /> Danford,CA 93230 <br /> Attention K <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy <br />