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WUMMnM <br /> Ultraimar Inc. / , eEacoN <br /> CHAIN OF CUSTODY REPORT Cl 7 ? s <br /> Beacon Station No. Sampl r(Print N ) 17 Date Form No. <br /> ANALYSES of <br /> 27— <br /> Project o. per S' iure) <br /> Project Looation <br /> U Irl <br /> x ---- o <br /> LUMM <br /> Sample NoAdentification Date Time Lab No. m CL z° REMARKS <br /> S — C/v W 2 G 1• I X'V/(-� <br /> Reli quish :(Sign . re/Affiliatio ) Date Time Received by: (SignalurelAffitiation) Date Time <br /> 4 &IIJIV 4/v <br /> I Relinq ! y: Signature/Affiliation) bate Tim Receiv y: (Signature/Affili tion) D to Time <br /> Relinquished by: (Signature/Affiliation) Date Time R eived by: (Signature/Affiliation) Date Time <br /> all <br /> Report To: I UU Bill LILTRAMAA INC. <br /> 525 West Third Street <br /> Hanford, CA 93230f- <br /> 9�� Attention: <br /> lC <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK:Originator Copy ue� � <br />