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Phone (916)535-0200 APEX ENVIROTECH, INC. send results to: <br /> Fax (916)535-0207 <br /> Sample Identification/Field Chain of Custody Record Apex Envirotech, Inc. <br /> 7844 Madison Avenue <br /> Site Address: �o�PR, �Ch(OLIIL. Lw/K (�S"T f�1� �' �/ �'�''� �� Suite 106 <br /> �L � Fair Oaks,CA 95628 <br /> Apex Project#: /� Q Z� 00� <br /> Shipped By: olso G�✓: / <br /> Shipped To: __ Hazardous Materials Suspected? <br /> Project Manager: )OP., lS�n w'� ❑ Yes No <br /> Sample No.of <br /> Sampling Point Location Field ID# Date Type Containers Analysis Required <br /> /� t Z� ti 5 l,,r, f e/ 3 (2Wa '1i,�, <br /> raw-6 \V <br /> Sampler(s)signature: <br /> Field ID Relinquished by (signature) Received by(signature) Date/Time Comments <br /> fi <br /> Sealed for shipment by: (signature) Date/I'ime: �V °� r 3 y Shipment Method: S�' l��'��►� <br /> Received for Lab by: (signature) Date/rime: �12�/Ysr' /� Comments: <br /> ' <br /> (YL <br /> Receiving Laboratory: Please return oris*-nal form after signing for receipt of samples. <br /> While/Original • Yt )j Lab • Pink/File Copy <br />