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FIELUSERVICES ) tt _ Client To Sample And Deliver To �ORNIA WATER LABS. I__: Sampling & Ana Plan Received. �� FIELD SERVICE REQUIREMENTS: Estimated Service 8 Service Rate Service Charge Route Surcharge: . . . . . . . . . . . . . . . . 0 To 25 Miles I . f 0.00 26 To 60 Miles $ 10.00 __) f________.__—_ 61 To 150 Miles ;__1 f 20.00 ll Non-Route Charge (Round Trip). . . . . . . . . . _. _ Miles z f 0.45 = f Field Service Labor ___f____ Hours z f 35.00 = f_ Light Duty Truck . . . . . . . . . . . . . . . . _________ Miles x $ 0.45 = f________._____ Heavy Duty Truck . . . . . . . . . . . . . . . . _________ Miles x f 0.65 = 1_-____._____ 1 Other Equipment/Labor As Listed Below: -------------------------------------------- --------- -------- x $-----'----- - $ -----'---- Field Charges --------------------------------------------- --------- — ---- xf--- -- - f------'----- --------- x f--- --- - f-------'----- HAZARDOUS MATERIAL: _I None I1 Biological . 1 Explosive/Ignitable 1I Pesticide Residuals I . Reactive Toxic Vapor 1 Required Personnel Protective Equipment And/Or Procedures: ---------------------------------------'-------------------------------'-------------------------------------------------- OTHER ) I QUALITY ASSURANCE/QUALITY CONTROL: : 1 Standard QA/QC Report Chain-Of-Custody Required I . CLP Equivalent Quote -------------- Report Charges SPECIAL REPORT REQUIREMENTS: Specify: ----------- ---- Quote f------'---- f DISPOSITION 1 1 Put On Normal Hold For 31 Days I Hold Beyond 38 Days To: __—/_— / Disposal Charges OF Return To Client (No Charge) or ____ Month (s) 1 15.00 Per Month SAMPLE 1 $25.00 Lab Disposal Surcharge To Client 11 Returned To Client On: —______ f TOTAL OTHER CHARGES f DISTRIBUTION: 1X11 Accounts Receivable 1X11 Client File 1XI1 Sample Control :X11 Client: C1s-� 1 Organic Lab 1 1 Inorganic Lab 1-1 Field Services 1 1 Other: --_---__ —__-- File: OFWPG2.FRM Page 2 of 2 Rev: 11/04/1989