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Laboratories, Inc. <br /> 12A773 PownhNZDfive Steamboat Sprigs,CO 80487 (800)334-5493 <br /> Name: Christie Brizinski Address: 131 E.Lincoln Ave Ste.200 <br /> Com any: Ensero Solutions Fort Collins, CO 80524 <br /> E-mail: cbrizinski@ensero.com Telephone: 867-668-6463,ext 229 <br /> Name: Evan Valencia E-mail:evalencia@ensero.com <br /> Compan : Ensero Solutions iTelephone: 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(HT),or if insufficient HT remains to complete YES <br /> analysis before expiration,shall ACZ proceed with requested short HT analyses? NO <br /> 11"100"UM A¢Ma eontw dw br urvw nsaueear.a mow-rm•W-W Is 1W"A,ACZ VAM PMG.W WM u M!U"W. yP Doan a NT b a�1rs4 sno a.e..e M WsiMM <br /> Are samples for SDWA Compliance Monitoring? Yes No LEE <br /> If yes,please include state forms.Results will be reported to PQL for Colorado. <br /> Sampler's Name: EV•JW Samplers Site Information State CO Zip code 80401 Time Zone MTN <br /> i h.n.amaraw�umvan,�srnow•iuea.w.naaarnex+aoroxrs+a�uramsN.r.M�> <br /> Samplers Signature: srso.isiwim n»s..gi.n..r..i r amid..a n.w wwsarow W ssra�. <br /> PROJECT INFORMATION <br /> ouote#. Ensero-2020 <br /> Poa: 3100-P0205 <br /> Reporting state for compliance testing: CO c y y a <br /> Check box if samples include NRC licensed material? Q p <br /> = E to <br /> SW-BPL 11-19-2021: 10:40 SW 8 0 ❑ ® ❑ © Q ❑ Q <br /> SW AWD 11-19-2021: 11:20 SW 8 Q Q ® Q Q Q Q Q <br /> ❑ ❑ ❑ ❑ Q Q ❑ Q <br /> ❑ ❑ © Q ❑ © ❑ ❑ <br /> ❑ ❑ ❑ Q ❑ ❑ ❑ Q <br /> ❑ o 1031 Q ❑ o ® Q <br /> ❑ ❑ ® Q ❑ ® ❑ Q <br /> ❑ ❑ ❑ ❑ Q Q Q Q <br /> ❑ Q Q Q 0 Q Q ❑ <br /> ❑ Q ❑ ❑ © Q ❑ ❑ <br /> Matra SW(Surface Water) GW(Ground Water)-W W(Waste Water) DW(Drinking Water)-SL(Sludge)-SO(Soil)-OL(Oil)•Other(Speafy) <br /> REMARKS <br /> This COC accounts for 16 containers.Shipped 11/22/2021 <br /> Please also send reports to importer@alexco.ehsdata.com <br /> 0 0 Please refer to ACZ's terms&conditions located on the reverse side of this COC. <br /> RELINQUISHED BY DATE:TIME RECEIVED BY: CATE*TIME <br /> 3 <br /> O <br /> C <br /> 015 <br /> MFRMADDS0.06.14.14 White-Return with sample. Yellow-Retain for your records. <br /> M 0091-2201271135 Page 23 of 23 <br />