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Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> 1lMhnr.rr <br /> Beacon Station No. Sampler(Print Name) `ate Form No. <br /> AN <br /> ALYSES <br /> 18,� I Of <br /> Project <br /> Project No. Sampler(Sign <br /> Project Location Afiliation <br /> Lou°zEMARKS <br /> S Ie Noilderrilication Date Time Lb � <br /> � <br /> Li <br /> Aw <br /> .� <br /> �AIO <br /> Relinquished b :(Sig nature/Atfiliation) Date Time Receiv r Iati Date Time <br /> Re' q b g u ffil' to Time Rete y: i t ion ate Time <br /> r <br /> li is Y S ) Date Time Received by: iation) Time <br /> Report To; Bal to: LICTR ARI C. <br /> 52.5 West Third Street <br /> Hanlord,CA 93234��� �� <br /> (q,�� 7�a -f�.`7 '7 Atterdion: <br /> WHITE:Return to Client with Report YELLOW:Laboratory Copy PINK:Originato:Copy �'°°""° <br />