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Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Fulnranui <br /> Beacon Station No. Sampler(Print Name) Dae Form N . —a <br /> �o n ANALYSES of <br /> Project No. S r(Signatu <br /> � <br /> Project Loc tion�A.� ,� rv✓cr Affiliation <br /> 3 y y? o <br /> +r-t Tc A/ Cep 9 :�2 GS C/�-Ic�rl 'r ,►,�c a, <br /> W 2 2 <br /> M CL Sample No./Identification Date Time Lab No. m C z REMARKS <br /> S—In w S5AA/ rn 'A 70 -�� <br /> s—M cv s - x�5 ��, �o lam.►. <br /> to .] <br /> 3 37 <br /> 301 <br /> Relinquished by: (S- nature/Affiliation) Date Time Received by: (Signature/Affiliation) Dae Time <br /> _ 11 .o /3h6 Y. Sv �_-Le- <br /> Relinquished <br /> b s(_i natu a/Affiliation) Date Time Received by: (Sign ature/Affiliation) Date Time <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> 4J <br /> Report To: (s� r ��i�Ytt�C Bill to: ULTRAMAR INC. <br /> /`,e.e1 r,v �:,,j/, ,CJ/y'r'+ter✓' �� 525 West Third Str �t <br /> ;ri)i E Hanford, CA 93230 <br /> rA Attention: ,a�. ►LC. `7iifh�'�^J ^� <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 32-80031'°° <br />