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• • <br /> Ultramar Inc. BEAC N <br /> t' <br /> CHAIN OF CUSTODY REPORT <br /> unramar <br /> Beacon Station No. Sampler(Print Name Date Form No. <br /> ANALYSES <br /> �C6:a'01-" -. I <br /> Project No. Sam r(%nature) <br /> zo Ur-�a <br /> 4---- 7— <br /> Affiliation c ` <br /> Project Location 2 o ` <br /> 7-o <br /> 1 <br /> f G rA � I l �G r-e/ w Z = o <br /> Sample No./Identification Date Time Lab No. m d F- z REMARKS <br /> r- <br /> i <br /> Relinquished by: (Sign elAffiliation) Date Time ceived by: (Si naturelAffi tion) <br /> Date Time <br /> elinqui5h y: (Sig <br /> /Affiliation) Date Time R ei ed by: Sign re/Affiliation) ate Time <br /> -3 1/4- <br /> R <br /> 3 1/4- <br /> Re in uished by (Signature/Affiliation) Date Time Received by: (Si 1 iRa ion) D e Time <br /> Report To: Bill to: L R M I <br /> 525 West Third Street <br /> C1'r Hanford, CA 9323 r ' <br /> r <br /> Attention. <br /> iax-eooa IM <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy <br />