B8 WOHL Sample Submission Form IH Surveys RIHSE.pdf

PDF 120 KB Posted

Attached to
RFQ - Industrial Hygiene Surveys Federal contract opportunity
Solicitation number
W912NS23Q1005
Issued by
Department of the Army National Guard

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This document is a sample submission form for industrial hygiene surveys from the Wisconsin Occupational Health Laboratory (WOHL). The form requests information on samples submitted including the customer name and contact information, sample details such as media used and area wiped, analysis requested, and chain of custody documentation.

The related federal contract opportunity is a solicitation from the Department of the Army National Guard for industrial hygiene surveys. The solicitation number is W912NS23Q1005 and is seeking proposals for required industrial hygiene surveys as part of the contract opportunity. Details provided on the form would be used to submit sample for analysis as part of fulfilling the contract requirements.

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Other files attached to RFQ - Industrial Hygiene Surveys, newest first.
File Type Posted
B8 Performance Work Statement IH Surveys RIHSE v4.pdf PDF
B8 Quote Template IH Surveys RIHSE.docx DOCX document
B8 Combined Synopsis Solicitation W912NS23Q1005 IH Surveys RIHSE.pdf PDF

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WISCONSIN OCCUPATIONAL HEALTH LABORATORY (WOHL) SAMPLE SUBMISSION FORM

Bill To WOHL COMP# Send Results To ATTN:

Phone #

FAX #

Email Address

Project

P.O. # Date Sampled

Turnaround: RUSH PRIORITY NORMAL { must be prearranged }

◆ PLEASE GROUP SAMPLES BY MEDIA USED AND ANALYSIS REQUESTED.♦

LAB USE ONLY WIPE SAMPLES FOR AIR SAMPLES ONLY

WOHL

SAMPLE #

CUSTOMER

FIELD #

SAMPLE

MEDIA

SIZE OF

AREA WIPED

EX: 2 IN x 2 IN

TIME

ON

TIME

OFF

TOTAL

TIME

(MINS)

FLOW

RATE

(L/MIN)

VOLUME

(LITERS)

ANALYSIS REQUEST

CHAIN OF CUSTODY: Relinquished Date Received Date UPS, Fed-Ex & Other Shippers US Postal Service Phone 608 224-6210 Sampling Questions Wisconsin Occupational Health Lab Wisconsin Occupational Health Lab 800 446-0403 WOHLsampling@mail.slh.wisc.edu 2601 Agriculture Drive PO Box 7996 FAX 608 224-6213 Web Page/Order Media Madison, WI 53718 Madison, WI 53707-7996 http://www.slh.wisc.edu/wohl

SPECIAL INSTRUCTIONS

SAMPLE CONDITION

OK

NOT OK

See Sample Receipt Record

Bill To 1: National Guard Bureau
Bill To 2: SE Regional IH Office
Bill To 3: 510 Plaza Dr., STE 1530
Bill To 4: College Park, GA 30349
WOHL COMP:
Phone:
FAX:
Project:
PO:
SPECIAL INSTRUCTIONS:
Check Box4: Off
Check Box5: Off
Check Box6: Yes
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