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ti Ultramar Inc. <br /> BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Unreimar <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> ANALYSES <br /> Project No. Sampler(Signature) <br /> Project Location, Affiliation = <br /> t N h O rF ' <br /> X 9� O \� c�-alt 1 ,�, ` ;1•,.. <br /> Lu 2 2 <br /> Sample No./Idenlifica lion Date Time Lab No. m a 1 z° REMARKS <br /> IJ <br /> `6 <br /> s <br /> Relinquished by: (Signal ure/Al filiation) Dale Time Received by: (Sign titre/Aff'talion) Date Time <br /> y. <br /> Relinquished by ignalure/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Relinquished by: (Signature/Affiliation) �i'` Date Time Received by: (Sig nature/Aftifi3 tion Q Dae Time <br /> Report To: Ril o: ULTRAMAR INC. <br /> 525 West Third Street <br /> Hanford, CA 93230 <br /> Attention: <br /> I <br />