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r ■rr rmm <br /> V�e'a ar inc. BEACON <br /> 1 CHAIN OF CUSTODY REPORT <br /> unionm <br /> Beacon Station No Sampler(Print Name Date Form No <br /> L ANALYSES <br /> Project No Sa ler ignature) <br /> C� <br /> q1, l Z <br /> Q1 C <br /> Project Location Affiliation <br /> (A c <br /> 0 <br /> Sample NoAdentlflcation Date Time Lab o m a 4 z° REMARKS <br /> (Y <br /> SPS � <br /> Re unshed by (Signature/Affiliali Date Time Received by (Signature/Affiliation) Date Time <br /> 40r' z O-✓ 1)112 <br /> R inquish by ignature/Affiis ion) Date Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Sir t <br /> C),r L t �'P✓ Hanford, CA 93230 <br /> Attention C <br /> °0°"'°° <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy <br />