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Ultratar Inc. <br /> BEAMON <br /> CHAIN OF CUSTODY REPORT <br /> / b'5 <br /> urran»ir <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> ANALYSES �I'�' of <br /> Protect No Sampler(Signature) c <br /> _ `� [ <br /> 74 7- <br /> Protect Location Affiliation <br /> U c <br /> QQQT <br /> «. <br /> LU X =CE = p <br /> Sample NoAdentiflcation Date Time Lab No m z REMARKS <br /> -�-�-�� <br /> 603 6 <br /> MW--z 1t0 <br /> M X1-3 (S)-5 <br /> 6 as <br /> 516 -- c-F <br /> 64(5- d V <br /> Relinquished by (Signature/Affiliation) Date Time Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affiliation) D to Time Received W (SignaturetAffilia ion) a e Time <br /> Relinquished by (Signature/Affiliation) Date Time eceived by (Signature/Affiliation) Date Time <br /> i <br /> 1w - -�,c L-vCh <br /> Report To Bit ULTRAM INC <br /> 525 West Third Street <br /> Hanford, CA 93230 <br /> Attention ka-,,.,.ext <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Originator Copy 3260031160 <br />