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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 /> �5 <br /> Site Address �t� �� �� ��J�+� , __►_`ate-t�-LG. , _ C Suite 106� Fair Oaks,CA 95628 <br /> Apex Protect# E 4A 02- - 80 <br /> Shipped By. N k <br /> Shipped To: Hazardous Materials Suspected? <br /> Project Manager- '- 1 - Gy s�l ka--- 9f- Yes ❑ No <br /> i <br /> i <br /> _ Sample No of <br /> Samplins Point Location Field IDN Date Type Containers Analysts Required <br /> r—VAS S&S1-0Tly !Z -o7- 7 V 114,lov- <br /> E <br /> !< uSf -0 P <br /> Sampler(s)signature ~ <br /> Field ID Relinquished by(signature) Received by(signature) Datefrlme Comments <br /> L4 /bL1 <br /> Alt A6 <br /> Sealed for shipment by (signature) Datelrime Shipment Method <br /> Received for Lab by. (signature) Datefrime comments, <br /> f qjY 4 a**% ItOA.. <br /> A.. <br /> Receiving Laboratory: Please return oriform after signing for receipt or samples. <br /> While!Onguml • Yello lib • Rnk 1 File Copy <br />