Request an Evaluation

1. Background Information
Site Information:
Site Name:*
Site location (town/city/state):*
Site Owner/Responsible Party*
State regulatory agency overseeing the work:
Federal regulatory agency overseeing the work:
History of spill and remedial efforts at the site:
Environmental Consultant:
Name/Company/Phone Number:
Email*
Preferred proposal deadline:*
Preference for a webinar with our technical experts where our evaluation will be presented:
- Yes
- No

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2. Remedy Options
Which remedial options are you currently considering?
Option Yes No Comment/Focus

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Geology and Hydrogeology Descriptions:

Use + to add more rows.

Name of layer described	Geology layer/ soil type (e.g. “silty sand”)	Top of layer [unit]	Bottom of layer [unit]	Location of groundwater table [unit]	Hydraulic conductivity [unit]	Hydraulic gradient	Seepage velocity in affected groundwater zones [unit]

Please include maps where the target treatment zone(s) are clearly identified.
Identify the treatment zone/zones*
Include scale bar (verify that scale and quoted area match)*
Please include cross-section (s) that clearly define the target treatment zone:
Show major layers
Show top and bottom of treatment interval
Identify source zones and plumes
Please include Soil Resistivity (or conductivity) samples from each distinct unit being treated.
Dynamic Resistivity Testing Results (Preferred)
Static Resistivity Testing Results
Please also include relevant information regarding site access restrictions:
Building footprints and/or clearance (identify locations on map)
Describe foundations and building type
Identified utilities present within the treatment zone (include map)
Do the business operations need to remain active during thermal implementation?
What type of operations are there within the business?
Can drilling and other related thermal remediation work be done inside the building?
Other general information pertinent to business operations and remediation*
Other site restrictions
Treatment Equipment (Vapor Phase/Liquid Phase):
Please describe existing equipment at the site (include sizes if possible).*

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4. COCs and Objectives
What is the overall objective of the remedy?
Please list the contaminants of concern and their concentrations in the table below. Press + for more rows.
Please list the contaminants of concern and their concentrations in the table below.
Press + for more rows.
Chemical Name Estimated Mass [unit] Groundwater (mg/L) Max Level Detected Groundwater (mg/L) Target Level Soil (mg/kg) Max Level Detected Soil (mg/kg) Target Level

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Chemical Name	Estimated Mass [unit]	Groundwater (mg/L) Max Level Detected	Groundwater (mg/L) Target Level	Soil (mg/kg) Max Level Detected	Soil (mg/kg) Target Level

1. Background Information