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i i i i i � i r � i I• i � � � i�' � <br /> Ultramar Inc. <br /> BEACON <br /> CHAIN OF CUSTODY REPORT <br /> UM�nMr <br /> Beacon Station No. Sam ler(Print Na Date Form No. <br /> ANALYSES ` of 2— <br /> Project <br /> - <br /> Project Noo.. L� / %� <br /> Sa ter(Sig u <br /> r / <br /> Project Location ratio - cc I--- <br /> Wo <br /> Sam le No./ldentification Date Time Crab No. m z REMARKS <br /> z 472 g' r C <br /> S / 073? <br /> S - low- e);7 v3 � <br /> S ^ 21p&12 --0r- <br /> 7 M <br /> -0r- <br /> 7/Ml <br /> R 'nquish,/ y:(Signa re/Affiliation) Date Time Received by:(Signature/Affiliation) Date Time <br /> d11rtaL) ,Cr 9 S 77 7 3t <br /> elinq6ished nature/Affiliation} Date Time I Received b ignature/Affiliate ) i 0ate Time <br /> Relinquished by: (Signature/Affiliation) Date Time R rued by: (Signature/Affiliation) Date Time <br /> U�L 4 <br /> Report To: Bill t • ULTRA R INC. <br /> Q ry �i�P r 525 West Third Street <br /> / Hanford, CA 93230 <br /> >C �'�.- `� 39-- 217"-- Attention: <br /> WHITE: Return to Client with Report YELLOW:Laboratory Copy PINK: Originator Copy 32.0003 IM <br />