Download Report

Sample Analysis and Chain of Custody Record
889 Montée de Liesse, Ville St-Laurent, Québec H4T 1P5
Telephone: (514) 448-9001
Fax: (514) 448-9199
2690 Avenue Dalton, Sainte-Foy, Québec G1P 3S4
Telephone: (418) 658-5784
Fax: (418) 658-6594
737 boul. Barette, Chicoutimi, Québec G7J 4C4
Telephone: (418) 543-3788 Fax: (418) 543-8994
www.maxxamanalytics.com
of
Other (specify):
Explosive EPA 8095
EPA 8330
TOTAL-PC
COLIF (Tot.)
COLIF (Fec.)
INOR.
Potable Water: ORG.
CUM ART. 10
RMD
RDS
ART. 11
Turbidity
COD
BOD5
Free CN
Ox.-CN
Tot.-CN
Sulfide (SH2)
TSS
P-Tot.
Total Sulphur (S)
TOC
THM
NO2 + NO3
NO3
NO2
SO4
Conductivity
Number
of
samples
pH
(date / time)
To be
filtered
NH3
Soil
Sampling
TKN
(sampling point)
Water
Type Other
Cl
Sample
Sample Identification
PH (C10-C50)
I hereby acknowledge the understanding and acceptance of Maxxam’s terms
and conditions as listed on the back of this form.
F
Sampler:__________________________
Others:
Sampler:__________________________
Selenium-soil
Fax:______________________________
Mercury
Fax:______________________________
16 ele. water***
Telephone: ________________________
Metals ICP regulation - 13 ele.-soil**
Telephone: ________________________
Heavy Metals (Cd, Cr, Cu, Ni, Pb, Zn)
Contact Name: ____________________
PCB (Congeners) (GC-MS)
Contact Name: ____________________
PAH
__________________________________
Project No.:
Phenols (Color.)
__________________________________
Quotation No.:
Phenols (GC/MS)
Address:__________________________
Project / Site:
MAH
Address:__________________________
Page
E-
Order No.:
BTEX
Company Name: __________________
VOC (EPA 624)
Company Name: __________________
O & G Tot.
Report Information (if differs from invoice)
O & G Min.
Invoice Information
Toll Free: 1-877-4MA-XXAM (462-9926)
LEGEND: ** Metals 13 elements (Ag, As, Ba, Cd, Co, Cr, Cu, Sn, Mn, Mo, Ni, Pb, Zn),
*** Metals 16 elements (Al, Sb, Ag, As, Ba, Cd, Cr, Co, Cu, Mn, Mo, Ni, Pb, Se, Na, Zn).
Types of Water: G = Groundwater
Sur = Surface
Applicable Regulations:
P = Potable LW = Liquid Waste
E = Effluent C = Catchment
(To complete)
Chain of Custody
Turnaround Time:
24h
48h
72h
Date:
Time:
Received by:
Relinquished by:
Date:
Time:
Received by:
Number of coolers:
Temperature upon reception:
Sample Transport:
By Client
MAXXAM Personnel
WHITE: MAXXAM ANALYTICS INC
Date:
General Condition at Reception:
Unless clearly identified all water samples received at Maxxam analytics will
be treated as non-potable and will not be subject to the requirements under
the Quebec Drinking Water Regulation.
Relinquished by:
KEENVCOCFORMQE - Saint-Laurent - 07/09
Regular
Remarks:
Courier (Specify):
BLUE: INVOICING
YELLOW: RETURN TO CLIENT WITH FINAL REPORT
PINK: CLIENT
MAXXAM TERMS & CONDITIONS
The following terms and conditions apply to the Services to
be provided by Maxxam Analytics Inc. (“Maxxam”). For the
purposes of this document “Services” includes the services
provided by Maxxam as described or reported on the
reverse side of this form, and includes all related services
and reporting thereon. In the event of a conflict between
these and any other terms and conditions contained in any
purchase order or other documentation relating to the
Services not specifically agreed to in writing by Maxxam,
these terms and conditions shall govern:
Liability:
Maxxam’s sole responsibility is to perform its Services in
accordance with commonly accepted professional
standards using accepted and where applicable accredited
testing methodologies and procedures, unless lesser
standards or methods are prescribed by the client named
on the reverse side of this form (“Client”). Maxxam’s liability
in connection with the performance or non-performance of
Services is to the Client only, and does not extend to the
Client’s or Maxxam’s successors, assigns, associates,
affiliates, officers, employees, directors, contractors,
customers or to any other third party, and is limited to the
actual cost of the specific analysis included in the Services.
Maxxam has no liability whatsoever for indirect,
consequential, exemplary, incidental, special or punitive
damages, including lost profits, even if Maxxam has been
advised of the possibility of such damages. Except as
aforesaid, Maxxam disclaims all warranties, express or
implied, including without limitation any warranties of
merchantability or fitness for a particular purpose. Client
agrees to indemnify and hold Maxxam harmless from all
claims, damages and losses including the cost of defense
in connection with or arising out of performance of the
Services, except only as aforesaid.
Confidentiality:
All results and information obtained by Maxxam will be held
in strict confidence unless (i) the Client directs otherwise in
writing, (ii) any disclosed information is at the time of its
disclosure or subsequently becomes generally available to
the public without breach of any confidentiality agreement
by Maxxam, or (iii) disclosure is compelled by law, in which
event Maxxam will use commercially reasonable efforts to
give Client prior written notice of any disclosure to be made,
and at Client’s expense, Maxxam shall cooperate fully with
Client to obtain protective orders, confidential treatment or
other such protective action as may be available to
preserve the confidentiality of the information required to be
disclosed.
KEENVCOCFORMQE - Saint-Laurent - 07/09
Insurance:
Proof of insurance is available upon request.
Minimum Charge:
A minimum charge of up to $250.00 may be applied to all
analytical work orders
Fees:
Published prices for analytical services may be subject to
change without prior notification.
Sample Storage:
Please contact a Maxxam customer service representative
for details and confirmation of the “no charge” storage
period for specific types of samples. Longer storage
periods than indicated are available upon request, but
additional charges may apply. Maxxam reserves the right to
return unused portions of samples to the client, at the
Client’s expense.
Sample Disposal:
For samples that require special disposal or that are found
to be hazardous, Maxxam reserves the right to return the
samples to the originating company or invoice the
originating company for the cost of disposal plus 10%.
For samples not requiring special sample disposal,
Maxxam reserves the right to charge for their safe disposal.
Water samples will have an up to $8.00/sample disposal
charge. Other samples will have an up to $8.00/kg disposal
charge.
All of the above disposal fees and their application, are
subject to prior agreement with Maxxam.
Hazardous Samples:
Samples which are suspected to be hazardous must be
clearly marked as such prior to submission to the
laboratory.
Terms:
Net 30 days, 1.5% service charge per month on overdue
accounts. Purchase order, cheque or credit application may
be required before work commences. Accounts overdue by
90 days or more may be referred to a collection agency.
Custom Analysis:
Maxxam has one of the most diverse ranges of capabilities
of any lab in Canada. If you require Analysis of samples, or
for parameters, that do not appear in this schedule of fees
please call us to discuss your needs. We will review your
requirements and provide you with a quotation based on
the scope of the project.
Chain of Custody:
Chain of Custody forms (“COC”) will be provided and must
be used. Complete instructions as to analysis and reporting
requirements and a signed COC must be provided with the
samples. Failure to do so may result in turnaround time
delays in processing samples or refusal to accept samples.
Sampling Supplies:
Sample bottles, cylinders, preservatives, labels and forms
are available when requesting services. Contact your client
service representative for minimum sample size
requirements and sampling protocols and/or to place an
order. Some sample containers are available only on a cost
or rental fee basis, please refer to your client service
representative for more details.
Samples for Legal Analysis:
Maxxam has both the expertise and documented
procedures to ensure proper handling of legal samples.
Please notify the laboratory for instructions prior to
sampling. Consultation, expert witness, legal analysis and
court appearance charges are $250.00 per hour or by prior
agreement.
Emergency Service: ( 24 hours or less )
For projects requiring immediate turnaround in emergency
situations, analysis will commence upon receipt of properly
documented samples and be worked on until completion
(during both normal and non-regular business hours).
Service offered only with prior arrangement with your local
Maxxam Lab. Rush service has up to a 100% surcharge on
list price. Overtime charges may also be applicable.
Rush/Priority Service: ( Within 48 hours )
For projects requiring expedited turnaround, a rush/priority
service is available. Analysis will commence immediately
upon receipt of properly documented samples and
continue during normal business hours. Analysis is normally
completed within 2 working days but confirmation must be
obtained from the laboratory prior to submitting samples.
Rush/Priority service has up to a 50% surcharge on list
price.