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a r <br /> ' 1 <br /> Ultramar Inc. OV ( BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Saler(Pri Name) Date Fop No. <br /> r <br /> ANALYSES - /-77of <br /> Project No. I/ Sam er( ig ature <br /> l�n ` r <br /> Project Location Affili ' n -- � <br /> 5ji/ M <br /> x rn� <br /> CL <br /> Sample NoMentification Date Time Lab No. m 1— 0 REMARKS <br /> Ref i heal: Si ature/Affiliation) D�a�� Time Received by: (Signature/Affiliation) Date Time <br /> %a3 lg5n <br /> Relinquished : Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Relinquished by:(Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> 5 I V;-o <br /> Report To: �r OarL <br /> r, � t o: IJLTRA INC. <br /> 525 West Third Street <br /> Hanford, CA 93230 <br /> ��/' X32' 2 ! Attention: <br /> WHITE: Return Cliieent with Report YELLOW: Laboratory Copy PINK: Originator Copy 32.E003 I M <br /> i <br />