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! i <br /> Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print me) Date Form No <br /> I-Aciit\ ZZ ANALYSES Z of <br /> Profsct No Sampler(Signatur <br /> a� <br /> Protect Location Zl$5 lL Afflllabon ~` m <br /> LO <br /> = o STF�-�DI�1D "�lo l <br /> Sample No lideMr�catton Date Time Lab No m e_� z REMARKS <br /> '�W 3 Z�Z3,g5 lZ' So 3 Imo, vzwu vd, ASS <br /> J,;Ct rTj F 05D <br /> TEMP <br /> lNtTi <br /> vil L--1 LAB <br /> 114 i <br /> Relinquished by (Signature/Affil Latton) Date Time Recei A1;gr=, !:: Date Time <br /> Reim y tur Af Dale Time R Time <br /> tnquts EyPji t n) Date Ttrae R tved 0 (SLgnature/Affilralion) I Q e Time <br /> t ay <br /> Report To 811110 ULTRAMAR INC <br /> 525 West Third Street <br /> /1••1'tV� Zai Hanford,CA 93230 <br /> Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy �+� � <br />