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Phone (916)535-0200 APEX ENVIROTECH, INC. Send results to: <br /> Fax (916)535-0207 Apex Envirotech, Inc, <br /> Sample Iden#icationlField Chain of Custody Record 3290 7844 Madison Avenue <br /> tA�r;re 1"efr^ u,., S)A (j,""t, 5 ql f )1 S�'�r ffa,���1 G4 Suite 106 <br /> Site address: � <br /> Fair Oaks,CA 956_8 <br /> Apex Project 11: Q Z. M,)j _ <br /> Shipped By: �t�''. <br /> Shipped To: eG n a c ltazmrdous Materials Suspected? <br /> Project Manager: �Idls 0 Yes f No <br /> Sample No.of <br /> Sampling Point Location Field IDN Date 'Type Containers Analysis Required. <br /> Jm <br /> h t4.1. <br /> - <br /> MV1 <br /> W ` �7 <br /> i - <br /> Sampler(s)signature: - <br /> Field ID Relmquislt by(signature) Received by(signature) Datetrime Comments <br /> t <br /> C <br /> ��� Datefrime:��l �L_—_Z • UJ Shipment Method: <br /> Scaled for shipment by:(signature.) <br /> Comments: v <br />` Received for Lab by:(signature) Date/I'inte:,L�/� -- <br /> Receiving Laboratory: Please return orjginat form after signing for receipt of samples. <br />