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Phone "S)535-0200 APEX ENVIROTECH, INC. Send results to: <br /> Faz (916)535-0207 <br /> Sample Identification/Field Chain of Custody Record 397] Apex Envirotech, Inc. <br /> /� ,/ 7844 Madison Avenue <br /> Site Address: ourC (et6t&' 13�}"1 1" {^ f ��9� I` ��, ��� Suite 106 <br /> Apex Project#: 6'/�n 02- o y <br /> Fair Oaks,CA 95628 <br /> Shipped By: � •� <br /> Shipped To: S �.r' t� Hazardous Materials Suspected? <br /> Project Manager: 'Niq & Ue / ❑ Yes 0�— No <br /> Sample No.of <br /> Sampling Point Location Field ID# Date Type Containers Analysis Required <br /> hw—� �Iy IV - <br /> Sampler(s)signature: <br /> Field ID Relinquished by(signature) Received by (signature) Date/Time Comments <br /> Sealed for shipment by:(signature) Date/Time: 1a�11�5`� ! Shipment Method: <br /> Received for Lab by:(signature) Date/Time:_)0131f U 30Q�`7 Comments: <br /> .. Receiving Laboratory: Please return original form after signing for receipt of samples. <br /> White/Original • Yell. lb • Pink 1 File Copy <br /> C <br />