Laserfiche WebLink
1�1 Client To Sample And Deliver To CALIF%,,..A WATER LABS. : 1 Sampling f Analysis F.WReceived. <br /> FIELD SERVICE REQUIREMENTS: Estimated Service ! Service Rate Service Charge <br /> :__1 Route Surcharge: . . . . . . . . . . . . . . . . 0 To 25 Miles —; f 0,00 <br /> . . . . . . • • • . . . . . 26 To 60 Miles ;—; f 10.00 ==> f , <br /> . . . . . . • . . . . . 61 To 150 Miles ;—; f 20.00 3 <br /> -------- ----- <br /> Non-Route Charge (Round Trip). . . . . . . . . . :� Miles x $ 0.45 = f 3l P <br /> 1 _; Field Service Labor . . . . . . . . . . . . . . �__ Hours : f 35.00 z <br /> Light Duty Truck . . . . . . . . . . . . . . . Miles x f 0.45 = f <br /> Heavy Duty Truck . . . . . . . . . . . . . . Miles x f 0.60 = 5 <br /> Other Equipment/Labor As Listed Belov: <br /> ---------------------------------------------------- --------- --------- x f---- ---- - f------- ----- <br /> Fie!d Charges <br /> -------—-------------------------------------------- --------- ---------- x f----- ---- f------- ----- <br /> ----------------------------------------------------- --------- ---------- x f----------- ° f------'----- D <br /> HAZARDOUS MATERIAL: <br /> None Biological :-1 Explosive/Ignitable ; 1 Pesticide Residuals : 1 Reactive 11 Toxic Vapor <br /> :__: Required Personnel Protective Equipment And/Or Procedures: <br /> --------------------------------------- ----------------------------------------- --------------------------------------------- <br /> --------------------------------------- --------------------------------------- ------------------------------------------ <br /> 0 T H E R I <br /> —; QUALITY ASSURANCE/QUALITY CONTROL: <br /> :__1 Standard QA/QC Report ; ; Chain-Of-Custody Required CLP Equivalent Quote f <br /> Report Charges <br /> SPECIAL REPORT REQUIREMENTS: <br /> Specify: ---------------------------------------------------------------------------- Quote f ---- f <br /> DISPOSITION : ; Put On Normal Hold For 30 Days :__1 Hold Beyond 30 Days To: ----/ /------- Disposal Charges <br /> OF Return To Client (No Charge) or __-_ Month(s) ! $5.00 Per Month <br /> SAMPLE <br /> $25.00 Lab Disposal Surcharge To Client :__1 Returned To Client On: / / f <br /> TOTAL OTHER CHARGES f <br /> DISTRIBUTION: :XX: Accounts Receivable :XX; Client File ;XX1 Sample Control 111; Client: _______________________________ <br /> Organic Lab 1—: Inorganic Lab 1__1 Field Services : ; Other., ------------------------------- <br /> File: <br /> ther:File: INTAKE2.FRM Page 2 of 2 Rev. 05/18/1988 <br />