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r r irr I� r I� � Ir � � Ir irr r■r �� r: <br /> Ultramar Inc. BEACON <br /> CHAIN OF CUSTODY REPORT IO V&;f <br /> ueranMr <br /> Beacon Station No. Sampf r(Print Nar�a}� ate Form No. <br /> ' ANALYSES C ` 9 7_of 2 <br /> Project No. Sa pier(Si <br /> Project Location • Affili bn = -a �` C/) <br /> a� <br /> X r.. <br /> w � = ° <br /> Sam le NoAdentification Date Time Lab No. I I z REMARKS <br /> 2 Z <br /> i <br /> -/t5 <br /> Reli quish `. (Signa e/Affiliation) Date Time Received by: (Signature/Affiliation) Date Time <br /> elin s ed { nature/Affiliation) ate Timev Received by ignature/Af i iatio ) 16a e Time <br /> Relinquished by:(Signature/Affiliation) Date Time Re <br /> ed by: (Signature/Affiliation) Date Time <br /> Report.To: Bili o: ULTRAMAR INC. <br /> 525 West Third Street <br /> l Hanford,CA 9 0 <br /> -74 <br /> Z_ 7 Attention: K 4 <br /> s �- <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy 12-°0031M <br />