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r_ Ultramar Inc. BEACON <br /> unre�r�ar CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Sampler(Print Name) Date, Form No. <br /> ANALYSES 511& of <br /> � ��€ �iff.-•isy.S <br /> Project No. Sampler(Signature) S;'-v J2�0 <br /> 1l Q <br /> i2 s - y <br /> Project Location Affiliation = <br /> '3�Y.3 F.�rin'tin1 R✓Fit/i� 03 <br /> Y �,� �C �1r'vJ <br /> o <br /> �P.c�urn�iJfPod- 1AX x 2'S U <br /> 0 <br /> Sample NoAdentification Date Time Lab No. m z REMARKS <br /> oA <br /> -53 <br /> �— <br /> -6 2 -6S 1 's) S61 1 z� <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: (Si nature/Affiliation) D 'te Time <br /> Relinquis e : (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) _ Date Time <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Dale Time <br /> f "------- - -- - .�--- , 1 1. r <br /> r3 S' <br /> Report To: C„�,��,134,v eeyt Bill to: ULTRAMAR INC. <br /> 1�.�.2r��,,s�jv v/1?[,hlrl+�r✓fvu t � � 525 West Third Stre <br /> 5'r��/ G�.�t7ErJ � c;7N1� f',Q L✓+i'rJ Hanford, CA 93230 <br /> 69 <2 S,�7ZL7 Attention: Arv,041-t. S fPry� Sn�� <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 32.80031M <br /> { <br />