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Unramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Umaimar <br /> Beacon Station No. Sampler(Print Name) Date Form No. 3 <br /> ANALYSES of <br /> Project No. Sampler(Signature) <br /> Project Location Affiliation CD <br /> �-ty3a a ! Uri+,n�Dvnr'1 <br /> �DC X'%0- ,,'_GS d✓1 pc,�.� E,�Jt/;l�v.,rrnc.✓T �, iC. <br /> CU a , 0 <br /> � _ _ o <br /> Sample No./identification Date Time Lab No. m r z REMARKS <br /> VV <br /> /Y)lv <br /> r , <br /> 11 ��� <br /> : d All f S-- <br /> Reli shed by (Signature) ifiliation) D to Time Received by: (Signature/Affiliation) Date Time <br /> tl-- s"/ <br /> Relinquished y. ignature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Relinquished by: (Signature/Affiliation) Dale Time Received by: (Signature/Affiliation) Date Time <br /> Report To: G,a/� n,t'Er Bill to: ULTRAMAR INC. <br /> 525 West Third Steet <br /> �6L�1J F2i67ML Zrd�w�y� Sc-.J E Hanford, CA 93230' <br /> / Attention: 0.a+Jr'r Z L <br /> cr`L <br /> 41-1,1A400 A)LLS J <br /> 32-8003 1100WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy <br />