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lone (916)535-0200 APEX ENVIROTECH, INC. Send results to: <br /> ir. (916)535-0207 Apex Envirotech, Inc. <br /> Sample Identification/Field Chain of Custody Record p <br /> 3372 7844 Madison Avenue <br /> ite Address: N�U�e I 'f Yee` I� I (ti^ 66,1 �4 l /9 Suite 106 <br /> �.� n 0-1CIO� �}2- ,�� � Fair Oaks,CA 9562$ <br />,pex Project#: /� <br /> hipped By: Ivy h AT)e / l <br />,hipped To: Seigel ��� ��J°'� Hazardous Materials Suspected? <br />'roject Manager: �l�', wl, we�/ El Yes No <br /> Sample No.of <br /> Sampling Point Location Field ID# Date Type Containers Analysis Required <br /> Sampler(s)signature: <br /> Field ID JWinquiiied by (signature) Received by(signature) Date rime Comments <br /> All <br /> JJ C- s/>>/p C/:3c) <br /> Sealed for shipment by: (signature)— ^ Date rime: <br /> 5 �17 t� � ��� Shipment Method: <br /> Received for Lab by:(signature) Date/time.. Comments: <br /> Receiving Laboratory: Please return origi Form after signing for receipt of samples. <br /> White/Original • Yellow/Lab • Pink/File Copy <br />