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i <br /> Ultramar Inc. BEACON <br /> ' CHAIN OF CUSTODY REPORT <br /> u nwnw <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> do q7 � nseANALYSES 1 7 of-/ <br /> Project No. Sampler(Signature) <br /> Project Location Affiliation -- - o <br /> x ~�ti 9~-~ rzC; <br /> Sample NoJldentificatbn <br /> Date Time Lab No. m REMARKS <br /> t44-W- f 3-z 7'q 7 /)J 0 Az a� <br /> M W V D <br /> Relinquished by:(Signature/Affiliation) Daig Time A;;92 <br /> ation) Dat Time <br /> 3Iz0Vi5n��� =ZL2_r� _=_ <br /> nquished by:( nature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> �Wo ev r -- <br /> A - Out <br /> Relinquished y: (Signature/Affiliation) Date Time Received by. (Signature/Affiliation) Date Time <br /> 1a3S' <br /> Report:To: Bill to: ULTRAMAR INC. <br /> 525 West Third Street <br /> Hanford, CA 93230 L <br /> Attention: <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy 32-SW3I 40 <br />