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Comments
Enhanced Fluid Recovery (EFR®) Request Form
Client Information:
Contact Name(s), Email and Office Phone # are required.
Name of Firm:
Office Phone #:
Contact Name(s):
Fax #:
Address:
Email:
City:
Cell #:
State:
Zip:
Facility Information:
Site Name:
Current Site Owner:
Type of Facility:
Active Site?
Yes
No
Site Phone #:
Address:
Is Water Available Onsite?
Yes
No
City:
State Facility ID#:
State:
State Regulator:
Zip:
Phone #:
Locked Gate or Compound:
Yes
No
Drums Requiring Content Removal?
Yes
No
Total Liquid Volume (gallons):
Drum Contents:
Drum Location:
Contaminant Type (check one):
Gas
Diesel
Mix
Other
Other Contaminant Type (specify):
EFR® Information:
Describe Restrictions on Performing Site Work (time of day, traffic concerns, special access, locked gate, etc.):
Duration of EFR® (if <or> 8 hrs.):
EFR® Objectives (check all that apply):
Remove Free Product
Remediate Soils
Reduce Dissolved Levels
Extraction Well:
Diameter (in.):
Depth to Liquid (ft):
SPH Thickness (ft):
Total Depth (ft):
Comments/Other:
Please also attach the following, if applicable,
and email them to
nick.athens@ecovacservices.com
Updated site map
Directions to the site (or site vicinity map)
Map to hospital and emergency numbers
Dissolved phase plume map(s)
Water table elevation map
Free product plume map
Adsorbed-phase (soil) plume map
Geologic cross-section(s) or boring logs
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