EFR Request Form

Please fill out the following form.

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):

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 fax/mail to EcoVac Services at (770) 592-1801:

Please provide us with the details of your site so we can evaluate the costs of the job. CLICK HERE

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