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Pho ''7 ib) 535-0200 APEX ENVIROTECH, INC. Send results to: <br /> Fax (916)535-0207 Sample Identification/Field Chain of Custody Record Apex Envirotech,Inc. <br /> n p 3598 7844 Madison Avenue <br /> We- �e���c,:� �3 � f� I se, }� �j�t,� ��a, � Suite 106 <br /> Site Address Fair talcs,CA 95628 <br /> Apex Project# <br /> Shipped By <br /> Shipped To Hazardous Matenals Suspected? <br /> Project Manager ;"' �' E) Yes No <br /> Sample No of <br /> Sampling Point Location Field ID# Date Type Containers Analysis Required <br /> All <br /> Hv- I B (d 7 f3 IL/Q 4 <br /> h�_ � ti <br /> Sampler(s)signature <br /> Received b (signature)� Field ID Relinquished by(signature) Y ( nature) Date rime Comments g <br /> Scaled for shipment by {signature} Date/Time Shipment Method <br /> Received for Lab by (signature) Date/Time Comments <br /> 3 Receiving Laboratory: Please return orig rm after signing for receipt of samples. <br /> white 1 Ongtnal • Yellow 1 Lzh • hnk 1 He Copy <br />