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Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> P`QO COX,5 ANALYSES I of <br /> Project No 1°ta�5 pg Sampler(Sig ure) <br /> 411,4 Vi <br /> Prged Lncat Zi ' � y Affiliation <br /> m � <br /> X <br /> SarrVe NoAdeMificabon Date Tule Lab No M z° REMARKS <br /> _ttmw 1 11}1Ly of 1 l SS 3 4�"�+QVoA 5CQ Pts . <br /> I rnw 3 S3'o� � <br /> 11• ao 3 <br /> r�.w S lZ• 5 o k to <br /> I <br /> Relinquished by (S ture/Affiliation) D Time I� =Pignalure/Anilialion <br /> ff ilia DateTime <br /> Ref�ri� (S A Iratr ate Time R } , Date Time <br /> y i9 tureJA Date Tire ecei0 ved by (SignarureiAtidiation) a ime <br /> Report To �c Bifl to ULTRAMAR INC <br /> 'Cwl fns D AT 5`4 4 �u` 525 West Third Street <br /> Hanford,CA 93230 <br /> Attention V, �of�i�ES-f <br /> WHITE Return to Client with Report W ES yAl' LaboratoryCopy PINK Originator Copy <br />