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Ultramar Inc. • <br /> BEACON <br /> CHAIN OF CUSTODY REPORT <br /> ulrarn.r � 3 <br /> Beacon Station No Sampler(Print Name) Date Form No <br /> 6 /0 /-/,q #q e4'S ANALYSES i of <br /> Project No Sampler(Si natur ) <br /> Project Location Affiliation <br /> o <br /> A*aew- <br /> x <br /> o <br /> Sam le Noildentificaiton Date Time Lab No m ►a— - I I I z°i REMARKS <br /> Z4 I- <br /> -7 <br /> Relinquished by (Sig nature/Affil tation) Date Time Received by (Signature/Affiliation) Dale Time <br /> � J o <br /> r � <br /> RejmquishAed <br /> by (Signature/Affilration) ate TiF2me Received by (Signature/Affiliation) Date Time <br /> Relinquished by (Signature/Affilialion) Date Time Received by (Signature/Affihalion) Date Time <br /> Report To Bill to ULTRAMAR INC <br /> 525 West Third Street <br /> Hanford,CA 93230 <br /> Attention <br /> WHITE Return to Client with Report YELLOW Laboratory Copy PINK Onginator Copy 32-M iso <br />