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UMMar Inc. <br /> BEAft N <br /> CHAIN OF CUSTODY REPORT _ <br /> u�e�■r j 5 J�I <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> ANALYSES 2^ - of <br /> Project No Sampl <br /> q q -- <br /> Project Location Affiliation <br /> oar/ Or/ t0� �0 <br /> a. <br /> Samp <br /> Ae No./ldentilication Date Time Lab No z REMARKS <br /> 94 N 4 �J- 10 kH M <br /> Relinq by S re/AffEliation) Date Time Received by (SignaturetAffdiahon) Date Time <br /> ve <br /> Re y (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <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 r�� L p �� <br /> 02- Attention �! <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 329MI ° <br />