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� � � � � � � I� � I• � r fi• � tilittttt■ � <br /> Ultra r Inc. BEAM <br /> CHAIN OF CUSTODY REPORT <br /> 11!MM <br /> Beacon Station No Sampler(Pnnt Name) Date Form No <br /> / J/ / 6 qry Ber ANALYSES Z of <br /> Project No Sampler(Signature) <br /> Project Location Affiliation ",,(Jot M a <br /> S Y-d o T <br /> CL <br /> w22 <br /> Sam le Noildentificaiwn Date Time Lab No a r- z° REMARKS <br /> �C- <br /> o <br /> X U - D �v cl f;n ' alb 1555 <br /> Reliquashed by (Si tura ffitiation) Date Time Rec ivy1py (S�gnaiurelA Uo D to Time <br /> 1 <br /> ��r Azov <br /> r,3 <br /> 1anR ul by (Signa f i on) to Time Received by Signat rel ffif anon) Date Tim)S40 <br /> Relinquishedby ( rgnatu e/Affdiation) Date Time Received by (Signature/Affiliation) Date Time <br /> Report To Bill to ULTRAMAR INC <br /> Q r l 525 West Third S reet <br /> Hanford, CA 9323 / <br /> Attention G� <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 324M3 IM <br />