I 2014 QA/QC study I ASK TO RECEIVE THE FOLLOWING SAMPLES:

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.
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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:
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manganelli@intercind.eu before 30
October 2014
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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
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Analytical Data Results should be insert in your Reserved Area on InterCinD website
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within 15
February 2015
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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 manganelli@intercind.eu 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 manganelli@intercind.eu 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 manganelli@intercind.eu
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