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401 <br /> Ultramar Inc. : <br /> BEA N <br /> CHAIN OF CUSTODY REPORT If <br /> 35-0 <br /> Beacon Station No Sampler(Print Name) DateForm No <br /> ANALYSES :�'� •�Date = <br /> of / <br /> Project No Sampler(Signature) J <br /> Project Location Affiliation <br /> m <br /> 0 � o <br /> w = x <br /> Sample NoAdentificatlon Date Time Lab No m z° REMARKS <br /> I Vo <br /> /UVJ-:� <br /> /V1 VJ1106 -04 <br /> Relin uished by (Signature/Affiliation) Date Time Received by (Signature/ filiation) Date Time <br /> L71) <br /> Relinquished by (Signature/Affiliation) Date Time Received by Signature/Affiliahon Date Time <br /> Relinquished by (Signature/Affili tion) Date Time Rec ved by (Signature/Affiliation) Date Time <br /> &&l .) /YA4 (w I <br /> Report To Bill o ULT AR INC <br /> 525 West Thirst Street <br /> Hanford,CA 9323 <br /> Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 32IMI 0 <br />