DGSI. Durham Geo Slope Indicator

Remediation Site Assessment Form

Printable Version

Complete as much information as possible and click on the submit button. Your request will be reviewed by one of Durham Geo's Technical Support Members and you will be contacted and provided with a site solution.

CUSTOMER INFORMATION
Company:
Date:
Contact: Phone:
E-Mail: Fax:
Title:  
Address:  
City:  
State:  
Zip Code:  
SITE INFORMATION
Site Location:
Job Reference #:
RECOVERY METHOD
Other:
WELL INFORMATION
Number of Wells:  If site has more than 4 wells Complete this section on another form and submit it.
Well Identification: Brief Description of Each Well Location
Well Diameter (ID): Specify in. or cm.
Total Well Depth: Specify ft. or m.
Product/Water Depth: Specify ft. or m.
Product Thickness: Specify in. or cm.
Water Table Rise/Fall Specify ft. or m.
Seasonal / Tidal: Water table changes due to Seasons or Tides
PRODUCT INFORMATION
Type of Product: Brief Description of Product
Product Viscosity: Enter Viscosity of Product Present
Discharge Head:  
Expected Flow Rate: Enter Numeric and Select Rate Below
Gallons Per D/H/M Select Rate of Removal gallons per Day/Hour/Minute
AIR INFORMATION
Distance to Air Source: Enter the Distance the Air Source
Air Supply Line (ID): Enter the Air Supply Line ID
Discharge Hose (ID): Enter the Discharge Line ID
Recovery Tank: Enter Approx. Distance to Product Recovery Tank
Air Compressor (SCFM):


Filtration on Compressor:



 
Special Site Conditions:
 
 
Bidding Phase:
Site Plan Available:


Delivery Date Required:
   
   

Complete as much information as possible and click on the submit button. Your request will be reviewed by one of Durham Geo's Technical Support Members and you will be contacted and provided with a site solution.