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i <br /> Unramalr Inc. BEACON <br /> CHAIN OF CUSTODY REPORT <br /> unranvi <br /> ion No. Sam ler <br /> Date Form No. <br /> Beacon StatPrint Name) <br /> (p <br /> ANALYSES �-30-941 1 f of <br /> 7// wLha elC�GG�uM <br /> Project No. Sampler (Signature) <br /> 14' . °' <br /> 7 <br /> Project Location Affiliation E <br /> 7-Ar <br /> Cz <br /> Sample NoAdentification Date Time Lab No. m z° REMARKS <br /> r'11 0.� y I I a <br /> ►� 3b - )ou -� sa-9L 3' �o oa x x <br /> i <br /> Relinquished by: (Signature/Affiliation) Date Time Rece' ed by: ignat /Affiliation) Dat Time <br /> Date Time <br /> Relin � e by. �gnature/Affiliation) D at Time Received y: (S�gnaturelAffifiatton) i <br /> r MOO <br /> Relinquishe by: (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> a f31 � oto <br /> Report To: Bill to: ULTRAMAR INC <br /> h r 525 West Third treet <br /> CnrY �,r�c� Hanford, CA 9323 <br /> AX-= 916 , 97-7. �.� Attention: — f�4� <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 3280031190 <br />