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V mar Inc. BE ON <br /> urtiinrr CHAIN OF CUSTODY REPORT <br /> Beacon Station No Sampl (Print Name Date Form No <br /> _ r ANALYSES 3 of <br /> r <br /> Project No Sampr(S a <br /> 1419tz f� <br /> Protect Location&� �� L Aff <br /> IT, 6 tn <br /> c <br /> n rfCa <br /> _ _ ° <br /> Sample NoAdentification Date Time Lab No ca t I z°i REMARKS <br /> s " 6 S13 "Z - g r Z 0 0 - � l Q Q✓e r- Y1 �� <br /> 4-1 <br /> S — O'S — 3, 13 h®r v,�' I�t_z <br /> S 0Mr o i s L4 <br /> s <br /> &44,1- zz ,� 1,:oc) - Z6 X v r <br /> Refi uish (Signat (Affiliation) Date Time Received by (Signature/Affiliation) _ _ Dale Time <br /> J� inqu ed (S nature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) a Rec ed b (Sign t re/Affiliation) D to Time <br /> Report To to ULTRAMAR INC <br /> 6 525 West Third Street <br /> Hanford,CA 93230 r <br /> r Zf? 2— Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy '��001A0 <br />