Jensen Technologies, LLC

Website: jensentechnologiesllc.com 15985 South Golden Road, Unit H Golden, CO 80401 Cell: 303-478-3929 E-mail: [email protected] SAMPLE SUBMISSION FORM Please include this form with samples (please print)

Today’s date: Project N0: Purchase order number: Date results are required: Project Name: Price: COMPANY INFORMATION (OR INCLUDE BUSINESS CARD) Company name: Contact for report: Phone number: Fax number: Street address: P.O. box: City: State: ZIP Code:

DESCRIPTION OF WORK REQUESTED Sample # Matrix Sample/Reference description (used in final report) Analytes

1 Check the Analyte required See Page 3&4 2

3

4

5

6

7

8

9

10

Number of samples: Date Received: Comments, including special billing, safety precautions, estimated sample value: There will be a sampling and handling fee for outside labs. All outside analysis will be billed directly. The terms are NET 15 days. No rush charges. The minimum is $50.

REPORTING (STANDARD TURNAROUND FOR RESULTS ARE 5 WORKING DAYS AFTER RECEIPT OF SAMPLE)  No report X Standard turnaround DISPOSITION OF SAMPLES AFTER ANALYSIS

 Discard samples after 3 months X Return samples after analysis Forward samples on to:

Include Contact: * Extra charge

1 Authorization Signature: Date: Project Manager

2 Price List Effective Jan. 1, 2011 Oil & Gas Produced Waters Water-Wastewater-Process Solutions-EMS Feed, Permeate, Concentrate Analyte Symbol Method Price $

Aluminum Al AA 20

Ammonia NH3-N Salicylate Colorimetric 20 Antimony Sb AA 20 Arsenic As GA-AA 50 Barium Ba AA 20 Boron B Carmine Photometric 20 Cadmium Cd AA 15 Calcium Ca AA 20

Carbon Dioxide tCO2 Gas Sensing Electrode 30 = Carbonate CO3 ASTM D513-82F - Bicarbonate HCO3

Chloride Cl- Mercuric Nitrate Titration 20 Chromium, Hexavalent Cr+6 Diphenylcarbohydrazine 20 Total Chromium tCr AA 20 Cobalt Co AA 15 Conductivity Electrode 15 Copper Cu AA 15 Cyanide, Free fCN- ISE Standard Addition 25 Silver Nitrate Titration Eh (ORP) Eh Pt Electrode 15 Fluoride F- ISE 25 Free Acid as Sulfuric Acid FA pH Titration 35 Hardness, Ca + Mg Hardness AA 30 Iron Fe AA 15 Iron, Ferrous Fe+2 Dichromate Redox Titration 20 Iron, Ferrous Fe+2 1,10 Phenanthroline 255 20 (0.02-3.00 mg/L Iron, Ferric Fe+3 Difference tFe- Fe+2 25 Lead Pb AA 15 Lithium Li AA 15 Magnesium Mg AA 20 Manganese Mn AA 15 Molybdenum Mo AA 20 Molybdenum as Mo+6 Mo+6 Ternary Complex 20

3 Nickel Ni AA 15

Nitrate NO3-N Dimethylphenol 20

Nitrite NO2-N Diazotization 20 pH Electrometric 10 Phosphorous, Ortho . Ascorbic Acid 20

-3 Phosphorous, Total PO4 -P Digestion-Ascorbic Acid 25 Potassium K AA 15 Selenium Se GA-AAS 50

Silica SiO2 Silicomolybdate 20 Silicon Si AA 20 Silver Ag AA 15

4 Sodium Na AA 15 Solids, Total TS Gravimetric 20 Solids, Dissolved TDS Gravimetric 20 Solids, Suspended TSS Gravimetric 20 Specific Gravity S.G. Gravimetric 25 Strontium Sr AA 20

Sulfate SO4 Turbidimetric 20

Sulfide, Free S-2 ISE 50 Thallium Tl AA 20 Thiocyanate SCN Photometric 25 Titanium Ti AA 20 Turbidity NTU Nephelometric 15 Vanadium V AA 20 Zinc Zn AA 15 Salinity NaCl Conductivity Meter 25

Total Metals Digestion HCl-HNO3 25 Total Dissolved Solids TDS Conductivity Meter 15 Guar Guar Phenol-Sulfuric 50 Photometric Temperature º C Thermometer 10 Gold Au AAS-Std Add 50

Carbon, Total Organic TOC Persulfate Digestion-CO2 50 Detection Oil & Grease O&G EPA Method 1164 63.00** Total Petroleum Hydrocarbons TPH EPA Method 1664 75.00*

TPH (C6-C32) GRO + DRO GRO- DRO SW-846 8015M 150.00*

GRO = Gasoline range organics *Wyoming Analytical Labs DRO = Diesel range organics **ACUTEST Mountain States There will be a minimum charge of $50.

5