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Tar Inc. <br /> BE ON <br /> CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampler(Pant Name) ate Form No <br /> L�/q `zfC ���� �� ANALYSES C� /3 �p of <br /> Protect No r l l lSam er �gnaiur ) <br /> Project Location Affiliation �- <br /> ►w- I = o <br /> Sam le Noildentification Date Time Lab No CO z REMARKS <br /> tf —_17 C) 3 G/ qq �a_' 3 p - 0( <br /> 17 as 'D <br /> o o -0q <br /> i <br /> RelI uis ed by ignature/Affihation) Date Time Received by (Signature/Affiliaiion) Date Time <br /> M <br /> (Signature/Affiliation) Date Time Received by (Signature/Af illation) Date Time <br /> / 6Me-5 <br /> Relinquished by (Sig nature/Affiliation) Date Time Received by (Signa)ure/Aitiliation) Date Time <br /> 3o7 <br /> Report To Bill to ULTRAMAR INC <br /> /�� �f/ 525 West Third Street <br /> Hanford,CA 93230 lei <br /> Attention � e#_Z <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Ongmator Copy 32.M IM <br />