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ADZ <br /> Laboratories, Inc. �- • ' <br /> 2773 Downhill Dfive Stearrrboat Springs,CO 80487 (800)334-5493 <br /> Name: Christie Brizinski Address: 131 E. Lincoln Ave Ste. 200 <br /> Company: Ensero Solutions Fort Collins, CO 80524 <br /> E-mail: cbrizinski@ensero.com Telephone: 867-668-6463, ext 229 <br /> Copy of Rcpor-t to: <br /> Name: Evan Valencia E-mail: evaeencia@ensero.com <br /> Company: Ensero Solutions Telephone: 818-688-1839 <br /> Name: Pauline Wong Address: 131 E. Lincoln Ave Ste. 200 <br /> Company: Ensero Solutions Fort Collins, CO 80524 <br /> E-mail: ap@ensero.com Telephone: 778-404-1182 <br /> If sample(s)received past holding time(H7),or If Insufficient HT remains to complete YES x <br /> analysis before expiration,shall ACZ proceed with requested short HT analyses? NO <br /> -wo-m...rZ.w ca..ct cww.r.r n.urr M.Y.cUon a MrM-yen 1or'No-a ndnc...d,wc2 W P Md.«n w.yu.u.d Y++r»•..v.n a M u.q+r.q W a.•..1d a p.rMW <br /> Are samples for SDWA Compliance Monitoring? YesLjaj No x <br /> H yes,please include state forms.Results will be reported to PQL for Colorado. <br /> Samplers Name: EV //AS/ampler's Site Information state CO Zip code 80401 Time Zone MTN <br /> P (� -1• .d», *—dty W r.Yely It dd.wqM.n vd-W thM Mamwn.tp mha'"W4 rti dm./dn./M�.rWn a <br /> *Sam Iees Signature: —oft wmw.,.p.M.y..,,s—rdwwfi a W-W.m.sys,..r... <br /> PROJECT •- • <br /> Quote#: Ensero-2020 � <br /> Po#: 3100-PO205 f0 <br /> Reporting state for compliance testing: CO c ai a <br /> 0 N w <br /> Check box if samples include NRC licensed material? ❑ `0 to E E <br /> SAMPLE s • s- at H o <br /> SW-BPL 6-15-2021: 9:30 SW 8 ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> SW-AWD 6-15-2021: 11:10 SW 8 ❑ ❑ x❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ 1 ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ 1 ❑ <br /> ❑ ❑ 1 131 ❑ ❑ ❑ 1 111 ❑ <br /> Matrix SW(Surface water)-Gw(Ground water) WW(waste water)-DW(Drinking water) SL(Sludge).SO(Soil)-OL(oil) Other(Specity) <br /> One cooler with 16 containers. Shipped 6/16/2021 <br /> Please also send reports to importer@alexco.ehsdata.com <br /> Please refer to ACTS terms&conditions located on the reverse side of this COC. <br /> 0 <br /> RELINQUISHED BY s• s By DATF TIME <br /> rn <br /> -' YtY (OP7 .IWo <br /> --O <br /> _C <br /> ttv FRMAD050.06.14.14 White-Retum with sample. Yellow-Retain for your records. <br /> = 1-66559-21 081 81 1 47 Page 23 of 23 <br />