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FIELD S E R V I C E S I <br /> Client To Sample And Deliver To CALIFORNIA WATER LABS. : : Sampling k Analysis Plan Received. <br /> FIELD SERVICE REQUIREMENTS: Estimated Service B Service Rate Service Charge7 <br /> Route Surcharge: . . . . . . . . . . . . . . . . 0 To 25 Miles f 0.00 <br /> • . . . . . . . 26 To 60 Miles ; ; f 10.00 <br /> __) f________ <br /> • • • • . • . . . . . . 61 To 150 f 20.00 <br /> X. <br /> Non-Route Charge (Round Trip). . . . . . . . . . es x f 0.45 = f22 <br /> Field Service Labor . . . . . . . . . . . z f 35.00 = <br /> Light Duty Truck . . . . . . . . . . . . . . . . Miles x s 0.45 = s <br /> Heavy Duty Truck . . . . . . . . . . . . . . . . Miles x f 0.60 = f <br /> Other Equipment/Labor As Listed Below: <br /> ----------------------------------------------------- --------- ---- -- x s----------- f-------------- <br /> Fie:d Charges <br /> ----------------------------------------------------- --------- ---------- x ----------- = f <br /> ------------------------z---------------------------- --------- ---------- x $----------- $--------'----- f <br /> HAZARDOUS MATERIAL: <br /> None ; Biological :__I Explosive/Ignitable 11 Pesticide Residuals 11 Reactive ; ; Toxic Vapor <br /> _; Required Personnel Protective Equipment And/Or Procedures, <br /> - - -- <br /> - - -------- --- - - - - ---- --------------- --------------------------------------------- <br /> 0 T H E R I <br /> _1 QUALITY ASSURANCE/QUALITY CONTROL, <br /> 1 Standard QA/QC Report 1 _ Chain-0f-Custody Required 11 CLP Equivalent Quote f <br /> _ Report Charges <br /> SPECIAL REPORT REQUlREMENTSs <br /> Specify: ------------------------------------------------- <br /> ------------------------ Quote f--------'----- s <br /> DISPOSITION 1 . Put On Normal Hold For 30 Days Hold Beyond 30 Days Tos ..../ / _______ Disposal Charges <br /> OF Return To Client (No Charge) or ____ Month(s) B $5.00 Per Month <br /> SAMPLE <br /> 1-1 $25.00 Lab Disposal Surcharge To Client 1__: Returned To Client On: -------- $ <br /> TOTAL OTHER CHARGES t <br /> DISTRIBUTION: ISI; Accounts Receivable ITC: Client File ;IT: Sample Control :TT: Client: <br /> Organic Lab 1 1 Inorganic Lab ; ; Field Services Other: _______________________________ <br /> File: INTAKE2.FRM Page 2 of 2 Rev: 05/18/1989 <br />