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Phone {916)535 f°'?0 APEX ENVI -gTECH, INC. Send-results to: <br /> Fax (916)53 .7 <br /> Sample Identification/Fie u chain of Custody Record Apex :trotech, Inc. <br /> 7844 Madison Avenue? <br /> Site Address: � 5_ o( � CLt:�4Lfi . r 35`74 Suite 106 <br /> Fair Oaks,CA 9562$ <br /> Apex Project#: //�- • �� <br /> Shipped By: <br /> Shipped To: 5 Hazardous Materials Suspected? <br /> Project Manager: To t" -"j4je4'1 ❑ Yes [ No <br /> Sample No.of <br /> Sampling Point Location Field ID# Date Type Containers Analysis Required <br /> :I&'y <br /> SIV- <br /> INV -41 <br /> Sampler(s)signature: <br /> Field ID Relinquished by (signature) Received by (signature) Date/time Comments <br /> Sealed for shipment by: (signature) Datefrime: 7 Shipment Method: <br /> Received for Lab by: (signature) Dat ime: —2c-,-4 - 1 4L) Comments: <br /> Receiving Laboratory: Please return original form after signing for receipt otsamples. <br /> White 1 Original • Yellow I tab Pink l File Copy <br />