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- -- r i C L J 0 t K V i L <br /> :--,; ,Client To Sample And Deliver To COORNIA WATER LABS. _: Sampling & Anal Plan Received. <br /> FIELD SERVICE REQUIREMENTS: Estimated Service a Service Rate Service Charge <br /> I Route Surcharge: . . . . . . . . . . . . . . . . 0 To 25 Miles !--I f 0.00 <br /> 26 To 60 Miles 1--i $ 10.00 =_) S <br /> . . . . . . . . . 61 To 150 Miles I : f 20.00 <br /> ; Non-Route Charge (Round Trip). . . . . . . . . . __`!J Miles x f 0.45 = f_ � . <br /> Field Service Labor . . . . . . . . . . . . . . ____�___ Hours x S 35.00 = f_ — .OJ <br /> Light Duty Truck . . . . . . . . . . . . . . . . _________ Miles x f 0.45 = $ <br /> Heavy Duty Truck . . . . . . . . . . . . . . . . _________ Miles x $ 0.65 = $ <br /> : Other Equipment/Labor As Listed Below: <br /> X S = f <br /> Field Charges <br /> x f = f <br /> ---------------------------------------------- - --------- x f---------- - f---------- f % . fd <br /> HAZARDOUS MATERIAL: <br /> None I . Biological : : Explosive/Ignitable I : Pesticide Residuals : : Reactive II Toxic Vapor <br /> Required Personnel Protective Equipment And/Or Procedures: <br /> --------------------------------'----------------------------------------------------------------------------------- <br /> OTHERI <br /> I QUALITY ASSURANCE/DUALITY CONTROL: <br /> I—1 Standard QA/QC Report : : Chain-Of-Custody Required : I CLP Equivalent Quote S____—_ <br /> Report Charges <br /> : SPECIAL REPORT REQUIREMENTS: <br /> Specify: ----------------------------------------------- -------- -- Quote f ---- -- - S <br /> DISPOSITION ;—1 Put On Normal Hold For 31 Days : I Hold Beyond 31 Days To: __—/ / Disposal Charges <br /> OF Return To Client (No Charge) or ____ Month (s) 1 $5.00 Per Month <br /> SAMPLE <br /> :__l $25.00 Lab Disposal Surcharge To Client I : Returned To Client On: 1 ___/—______ S <br /> TOTAL OTHER CHAR6ES $ <br /> DISTRIBUTION: ;II; Accounts Receivable ;III Client File :II; Sample Control IIS: Client: �� 1m <br /> Organic Lab lI Inorganic Lab I—I Field Services I^I Other: <br /> File: OFWP62.FRM Page 2 of 2 Rey: 11/04/1919 <br />