MDPE Site Information Questionnaire | Home | Clients | FAQs | Request Proposal | Contact Us |
Client Name:
Client Project Manager(PM):
PM's Phone:
Type of Facility:
Gas Station LPST No:
Pipeline       Facility Id:
Other           Description:
Facility address:
Objectives for Mobile Dual-Phase Extraction (MDPE):Remove Phase Separated Hydrocarbons? 

Remediate soil contamination?

Reduce dissolved phase concentrations?

Select the type of contaminants:Gasoline       Diesel     Others        
MDPE Extraction point well number: 
Approximate Static Water Table Depth: ft.
Approximate PSH Thickness: ft.
Well construction diameter: inches
Total well depth(s): ft.
Is potable water available on site?Yes No
Special well cap or vault keys req? Yes No
Flush Mount Wells?Yes No
provide detail on restrictions for performing MDPE:
Is the Site Active? Yes No
What will be the duration of MDPE ?8 hrs  12 hrs 16 hrs 24 hrs 72 hrs
Provide the waste disposal facility location:
Name:
Organization:
Would you like us to remove liquids from onsite drums?Yes No
Do drums contain purge water/PSH? Yes No
What type of contaminants are stored in drums?Gasoline       Diesel     Others        
Your Comments:(Please email an updated SiteMap and directions at brianburgess@envac.com   )

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