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Phor.- ";6)535-0200 APEX ENVIROTECH, INC. Send results to: <br /> Fax (916)535-Q207 ' <br /> Sample Identification/Field Chain of Custody Record Apex Envirotech, Inc. j <br /> nn 7844 Madison Avenue <br /> SiteAaaress Ood�'e 44G '�� 13 �` Sen /�14� sect Suite 106 <br /> .32- 2. Fair Oaks,CA 95628 <br /> Apex Project# 1e - <br /> Shipped By �`�• y/�� <br /> Shipped To C' V / Hazardous Materials Suspected? <br /> Project Manager 'rov'' die ❑ Yes a No <br /> RECEIVED APR 0 7 1994 Sample No of <br /> Sampling Point Location Field ID# Date Type Containers Analysis Required <br /> M� - 2 <br /> MY - 2 <br /> Sampler(s)signature ^ <br /> Field ID Relmq ed by (signature) Received by(signature) Date/rime Comments <br /> Sealed for shipment by (signature) W+ Datef rime _�I�I /0��UJ __ Shipment Method ✓� � <br /> Received for Lab by (signature) Date/Time Q Comments <br /> Receiving Laboratory: Please return orig orm after signing for receipt of samples. <br /> White I Onginal - Yellow/Lab - Nnk 1 Fite Copy <br />