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Phone (916)535AW APEX ENVI TECH, INC. Senults to: <br /> Fax (916)53 7 pex Elootech, Inc. - <br /> Sample IdentlficatlonlFie Chain of Custody Record 5-047 <br /> 7844 Madison Avenue <br /> Site Address. Mwft (AY0 ku w.- / 311 C 0 5f ct�i k Suite 106 <br /> i _t r_��� <br /> Apex Protect#.� <br /> , N 02Fair Oaks,CA 95628, <br /> ..OC3�,. - - -------- <br /> Shipped BY <br /> Shipped To. �� Hazardous Materials Suspected) <br /> Project Manager _ T�- Yes ❑ No <br /> Sample No of <br /> Sampling Point Location Field 1D# Date Type Containers Analysis Required <br /> f Io�-� u�e�•- 01., [e 7-5—7<;7 Ua ay f X t <br /> G Y 5 .... K Ort c L C'4 5 — S r 9STA <br /> Sampler(s)signature <br /> Field ID Relinquished by(signature) Received by(signature) Date/rune Comments <br /> Sealed for shipment by.(sigitatitm)=�1� Date/Tune Shipment Method � L <br /> Received for Lab by (signature) Date/Time Comments A re-i, T3 A <br /> c ok A Pit i tn,e- �.x�— a ilaj lex- k 0 (WL l SSS- 6 2- 4 7 - ----- <br /> Receiving Laboratory. Please return original form after signing for receipt of samples <br /> Whue 1 Onstnal • Yellow 1 l.ab • Pink 1 Fde Copy <br />