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Ultramar Inc. - <br /> BEACON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No. Sampler(Print Name) Date Form No. <br /> 47 ANALYSES `r - I / of <br /> Project No. Sampler(Signature) <br /> Project Location <br /> Affiliation G = ; <br /> ;►. O N o <br /> w <br /> CL <br /> rS <br /> Sample NoJldentification Date Time Lab No m a 21 REMARKS <br /> V11- it <br /> Al `3 <br /> 6 it-7 <br /> -IT <br /> WIS <br /> Relinquished by:(Signature/Affiliation) D to Time Received by:(SignaturelAffiliatio ) Date Time <br /> I <br /> Relinquish y:(Signature/Affiliation) Date Time Received by:(SignaturetAffiliation) Date Time <br /> I <br /> i <br /> Relinquished by: (Signature/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> Report To: Bill to: ULTRAMAR INC. <br /> 525 West Third Street <br /> Hanford,CA 93230 <br /> Attention: . . . J <br /> WHITE: Return to Cliient with Report YELLOW: Laboratory Copy PINK: Originator Copy 32-003 IM <br /> k <br />