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• i <br /> r <br /> Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> lalr�r 1 / <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> ANALYSES 1 of <br /> Project No Sampler(Signature) <br /> Project Location Affiliation o <br /> o <br /> Sam le Nolldentification Date Time Lab No m EL z REMARKS <br /> Al UJ- 4ql -73 4( i <br /> 11 <br /> V til-3 n /1V1 I <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> ehnqu sh by (Sig nature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (SignaluretAffiliation) Date Time <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Street <br /> C✓�✓ ��'"�- Hanford,CA 93230A- <br /> Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 32MIM <br />