3° InterCinD 2014 QA/QC study I’D LIKE TO SUBSCRIBE TO 3° InterCinD 2014 QA/QC study and I ASK TO RECEIVE THE FOLLOWING SAMPLES: ENVIRONMENTAL INDUSTRIAL FOOD Natural Sediment Ash from biomass boiler River Fish Q.ty Q.ty Q.ty (Q.ty =1means 3 bottles/rates of the same matrix) ANALYTES IN THE SAMPLES: A. Organic Micropollutants (POP) : PCDD/F, PCB-DL, PCB-ICES6 (28, 52, 101, 118, 138, 153, 180), PCB (95, 99, 110, 128, 146, 149, 151, 170, 177, 183, 187), Total-PCB, PBDE, PAH, B. Inorganic Metals (HM and Metals) Moreover I ASK TO RECEIVE: STANDARD SOLUTION Blind Standard Solution for the target compounds (subject to availability): Dioxin/Furans PCB PBDE Metals Please READ carefully the following DETAILS FOR PARTECIPANTS TO InterCinD III study and INSTRUCTIONS (see IO01) Dear INTERCIND III Partecipants: First of all thanks a lot for your Interest in InterCinD PTx. If you are interested in INTERCIND III partecipation please read the following Instructions. - To subscribe the InterCinD III CIRCUIT, please send back this form duly fulfilled to: InterCinD Organization (to Dr.ssa Simona Manganelli) by e-mail to: th [email protected] before 30 October 2014 th - Samples will be sent to participants before 15 November 2014 (after completed subscription steps and payment receipment). Please remember that package for any sample is: 3 bottle/sample - Analytical Data Results should be insert in your Reserved Area on InterCinD website th within 15 February 2015 MD11 Rev02 240914-Scheda Iscrizione HOW TO PROCEED: 1. Fulfill the form Please ship the samples to (SHIPMENT ADDRESS): NAME _____________________________________ ________________________ Company/Lab /Agency___________________________________ __________ Address_____________________________________ __________________________ ZIP code_________________ TOWN _____ ____COUNTRY_______________________ E-mail ____________________________________ ___________________________ Ph_______________________ __________ Fax ____ ___________________________ And Invoice to (INVOICE ADDRESS): LAB /AGENCY _________ ________________________________________________ Address__________ ____________________________________________________ ZIP code_________________ TOWN _____ ____COUNTRY_______________________ E-mail to send the invoice ______________________________________ _ _________ Ph__________________ _______________ Fax _________ ___ _________________ VAT (PIVA) N°____________ ________ ____________ ________________________ CARRIER N° (Optional)_______ ____________________________________________ Privacy Disclaimer and Authorization If Organization (not InterCinD) ask for my Company Reference, I authorize LabService/InterCinD to give my Company info for further contact about: a- Technical and scientific purpose Date……………………….Signed…………………………………..Name……………………………… b- Advertising purpose Date……………………….Signed…………………………………..Name……………………………… PRIVACY. Informativa e consenso ai sensi del D. Lgs. 196/2003. - Il trattamento dei dati che La riguardano viene svolto nell’ambito della banca dati elettronica di LabService Analytica srl e nel rispetto di quanto stabilito dal D. Lgs. 196/2003 sulla tutela dei dati personali. Il trattamento dei dati è effettuato per finalità gestionali, statistiche, promozionali e commerciali e allo scopo di informarLa ed aggiornarLa su servizi e prodotti offerti da LabService Analytica. I dati personali conferiti potranno essere comunicati, nei limiti di cui al D. Lgs. 196/2003, ai nostri agenti, distributori o soggetti incaricati di effettuare servizi per nostro conto. Ella potrà richiedere in qualsiasi momento la modifica o la cancellazione dei dati scrivendo all’attenzione del Responsabile Dati della nostra Società. Fax 051732759 The use of your personal data is in compliance with Legislative Decrete 196/03 and In order to process your subscription, we collect company details from you. These details may include (where applicable) reference names, addresses, telephone numbers, e-mail and IP addresses, or payment details. Your data may be used for the following purposes: contacting you for further info or PTx changing details , credit or other payment check, statistical and marketing analysis, systems testing, customer surveys and customer relations communications. We may also disclose your information to contracted companies who act as "data processors" on our behalf, or with your agreement to ancillary. We follow strict security procedures in the storage and disclosure of information. Our security procedures require that we request proof of identity before we disclose sensitive information regarding your Company data. If you prefer to delete your data from our database, please write to [email protected] or fax to +39051732759 2. Choose samples and standard (please check): PROMO: SPECIAL 10% DISCOUNT FOR SUBSCRIPTION RECEIVED BEFORE 5th October IF YOU HAVE A PROMO CODE, PLEASE INSERT HERE MD11 Rev02 240914-Scheda Iscrizione (not for Standards) InterCinD III Price List: the following price list can be configured considering the kind of analysis your Lab want to participate. Please check 1 sample Organic (POPS) and Inorganics (HM) 800 EUROS 2 sample Organic (POPS) and Inorganics (HM) 950 EUROS 3 sample Organic (POPS) and Inorganics (HM) 1050 EUROS 1 sample Organic (POPS) 650 EUROS 2 sample Organic (POPS) 850 EUROS 3 sample Organic (POPS) 950 EUROS 1 sample PCB & PAH 400 EUROS 2 samples PCB & PAH 500 EUROS 3 samples PCB & PAH 600 EUROS 1 sample HM 400 EUROS 2 sample HM 500 EUROS 3 sample HM 600 EUROS If you like to choose different kind of samples, for different kind of analysis, you can consider the price for 1(or more ) sample and sum the cost od the analytes selected (f.ex 1 POP Sediment+1HM ash+1 PCB&PAH Food= 650+400+400=1450 Euros) (f.ex 1POPs&HM ash+2samples HM sediment and food= 800+500= 1300 Euros) PCDDs/Fs 1 blind Std Solution 50 EUROS Check among: PCBs PBDEs Metals 2 or MORE blind Std Solution 100 EUROS Check among: PCDDs/Fs PCBs PBDEs Metals TOTAL AMOUNT DUE ………………………………………..EUROS(+VAT if due) 1. Send this form to [email protected] or fulfill the same format on www.intercind.eu and if required by your Company send a formal purchase order with any detail for your management within 30th October 2014 2. Receive the pro-forma invoice, proceed with the payment for the amount due (if possible before 15th November 2014). If your account Dept. needs info or find problems, please contact [email protected] 3. At the end of the subscription steps and after payment received, InterCinD will ship the required samples by carrier-Please remember that package for any sample SET is: 3 bottle/sample. You will receive by e-mail detailed instruction for the Reserved Area Registration on www.intercind.eu (Details in IO02 that your Lab will receive within 3 days after the samples shipment) 4. After your access to the website reserved area You’ll receive your LAB Number, info about the analytes range and the excel form for the data transmission (MD19). 5. Insert your final data in your reserved area (www.intercind.eu) within 15th February 2015 and Record on your Agenda the Official Presentation Day in Italy ! (Spring 2015) 6. Final Results Report and Partecipation Degree available on June 2015 Thanks again for your interest and collaboration! For any info, question or request, please CONTACT US! Regards InterCinD Staff - Simona Manganelli Please consider that some activities could be subcontracted MD11 Rev02 240914-Scheda Iscrizione