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Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No, Sampler(Print Name) DateNo. <br /> I-am <br /> ANALYSES of <br /> project No. Sampler(Signature)rol <br /> Project Location Affiliation <br /> x <br /> W z M <br /> CL <br /> Sam e NoAdentiflication Date Time Lab No. m a- <br /> z REMARKS'----- <br /> IVED <br /> �T <br /> T(.-..f4 p <br /> (NI ;AL <br /> WEST A <br /> A <br /> Relinquished by:(Sign?(ure/Affiliatio�n Date Time Received re/ Date Time <br /> Relinquished b _fNel Time -1Rete' :1*1*1 tion Time <br /> Date m e Received b -(S* tion) Dale Time <br /> Reiinw—*Q 6 Y. <br /> Report TO: L- <br /> Bill to: RA INC. <br /> 525 West Third Street <br /> Hanford,CA 93230 <br /> Attention: <br /> WHITE: Return to Client with Report YELLOW:Laboratory COPY PINK:Originator Copy <br />