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' FIELD S E R V I C E S I <br /> Client To Simple And Deliver To CALIFORNIA PATER LABS, ; ; Sampling & Analysis Plan Received. L bury <br /> FIELD SERVICE REQUIREMENTS: 9 V <br /> Estimated Service 8 Service Rate Service Charge h� <br /> Route Surcharge: . . . . . . . . . . . . . . . . 0 To 25 Miles f 0.00 <br /> • • • • • • • • • • • . . . 26 To 60 Miles : : $ 10.00 __> f________•_ <br /> 61 T 150 ' <br /> . • • o � � f 20.00 ---- <br /> -- f <br /> Non-Route Charge (Round Trip). . . -_-__- es x $ 0.45 = <br /> Field Service Labor . . . . . , , . , , , , x f 35.00 = f 35 . 00 <br /> Light Duty Truck . . . . Miles x f 0.45 = f <br /> Heavy Duty Truck . . . Miles x f 0.60 = f <br /> Other Equipment/Labor As Listed Below <br /> ------------------------------------------ --- --------- --------- x $----- ----- _ $-------- ----- <br /> Fie!d Charges <br /> ------------------------------------------- --- --------- ---------- x -------- - $-------------- <br /> -------------------------I---------—--— <br /> ------- ---------------------------------------------- -- --------- --------- x $----- ----- _ $-------------- <br /> HAZARDOUS <br /> ------- -----HAZARDOUS MATERIAL: <br /> None ; ; Biological Explosive/Ignitable :__I Pesticide Residuals :__: Reactive :__I Toxic Vapor <br /> Required Personnel Protective Equipment And/Or Procedures: <br /> ----- ----- - -- ------- --- - -------------•---------------------------------------------- <br /> ---------------------------------------'-----------------------------------------'---------------------------------------------- <br /> OTHERI <br /> : : QUALITY ASSURANCE/QUALITY CONTROL= <br /> :__I Standard QA/QC Report : _ Chain-0f-Custody Required : : CLP Equivalent Quote $ <br /> Report Charges <br /> !--I SPECIAL REPORT REQUIREMENTS: <br /> Specify: ---------------------------- ------------------------------------ Quote $------- --- f <br /> DISPOSITION ;__; Put On Normal Hold For 30 Days Hold Beyond 30 Days To: _— /_ / ____ Disposal Charges <br /> OF Return To Client (No Charge) or ____ Month(s) t $5.00 Per Month— <br /> SAMPLE <br /> ,__: $25.00 Lab Disposal Surcharge To Client ;—: Returned To Client On: !—__/________ $ <br /> TOTAL OTHER CHARGES f <br /> DISTRIBUTION: :XII; Accounts Receivable :XI: Client File :XX: Sample Control :XX: Client: _______________________________ <br /> :__: Organic Lab :�: Inorganic Lab : : Field Services : : Other: <br /> File: INTAKE2.FRM Page 2 of 2 . Rev: 05/18/1388 <br />