EZVI-CH4™	Provect-CH4™	Provect-IR™	Provect-IRM™	Provect-OX™

Name: Click here to enter text . Company: Click here to enter text .
Address: Click here to enter text .
Email: Click here to enter text . Phone: Click to enter text Fax: Click to enter text

SUMMARY OF SITE CONDITIONS:

Site Location: Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text .
Site Description (e.g. historical use, buildings, source of contamination, current remediation activities, etc.):

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Note: Attach – Site maps containing water table data, contaminant data, and any other maps available.

SITE GEOLOGY

Description of top geologic unit Click to enter text .	General Thickness Click here .
Description of 2nd geologic unit Click to enter text .	General Thickness Click here .
Description of 3rd geologic unit Click to enter text .	General Thickness Click here .
Description of 4th geologic unit Click to enter text .	General Thickness Click here .

IMPACTED AQUIFER CHARACTERISTICS (for more than one unit, attach characteristics)

Hydraulic Gradient Click here to enter text.	Hydraulic Conductivity Click here to enter .

Vertical Hydraulic Gradient Click here to enter text.	Vertical Hydraulic Conductivity Click here to enter text.

Effective Porosity Click here to enter text.	Linear Ground Velocity Click here to enter text.

Which geologic unit is it? Click here to enter text.

Note: Attach – All Lithologic logs and construction logs of monitoring wells in plume area, if available.

GEOCHEMISTRY (Please list available geochemical data in below table):

Geochemical Parameter	Typical	Minimum	Maximum
Redox Potential (mV)	Click here.	Click here.	Click here.
pH	Click here.	Click here.	Click here.
Total Organic Carbon (mg/L)	Click here.	Click here.	Click here.
Dissolved Oxygen (mg/L)	Click here.	Click here.	Click here.
Total Manganese (mg/L)	Click here.	Click here.	Click here.
Dissolved Manganese (mg/L)	Click here.	Click here.	Click here.
Nitrate (mg/L)	Click here.	Click here.	Click here.
Nitrite (mg/L)	Click here.	Click here.	Click here.
Total Iron (mg/L)	Click here.	Click here.	Click here.
Dissolved Iron (mg/L)	Click here.	Click here.	Click here.
Sulfate (mg/L)	Click here.	Click here.	Click here.
Sulfide (mg/L)	Click here.	Click here.	Click here.

REMEDIATION STRATEGY:

Source Zone Remediation Click to enter text . Total Plume Clean-Up Click to enter text .

Plume Containment (PRB) Click here to enter text.

Note: Please specify targeted treatment area dimensions and concentrations in relevant sections below.

How many wells? Click to enter text . What is their diameter? Click to enter text .

What is the length of screened interval (from x ft to y ft below ground surface) Click to enter text .

What is the depth to groundwater (ft below ground surface) Click to enter text .

SOURCE ZONE

Width of Source Zone Click to enter text .	Length of Source Zone Click to enter text .

Depth to Top of Source Zone Click to enter text .	Thickness of Source Zone Click to enter text .

Depth to Water Table Click here to enter text .	Depth to Bedrock Click here to enter text .

Is there pure phase product on site? If so, which COI’s? Click here to enter text .

List primary constituents of interest with concentrations measured in source zone below table:

Constituent of Interest	Minimum Conc. (μg/L)	Average Conc. (μg/L)	Remedial Goal (μg/L)
Click here.	Click here.	Click here.	Click here.
Click here.	Click here.	Click here.	Click here.
Click here.	Click here.	Click here.	Click here.
Click here.	Click here.	Click here.	Click here.
Click here.	Click here.	Click here.	Click here.

PLUME

Width of Plume Click to enter text .	Length of plume Click to enter text .

Depth to Top of Plume Click to enter text .	Thickness of Plume Click to enter text .

Depth to Water Table Click to enter text .

List primary constituents of interest with concentrations measured in plume area in below table:

Constituent of Interest	Minimum Conc. (μg/L)	Average Conc. (μg/L)	Remedial Goal (μg/L)
Click here.	Click here.	Click here.	Click here.
Click here.	Click here.	Click here.	Click here.
Click here.	Click here.	Click here.	Click here.
Click here.	Click here.	Click here.	Click here.
Click here.	Click here.	Click here.	Click here.

PERMEABLE REACTIVE BARRIER (PRB) OPTION:

PRB Length Click here to enter text . Depth to Top of PRB Click here to enter text .

Depth to Bottom of PRB Click here to enter text .

Inflowing concentrations (list constituents and expected concentrations below):

Constituent of Interest	Minimum Conc. (μg/L)	Average Conc. (μg/L)	Remedial Goal (μg/L)
Click here.	Click here.	Click here.	Click here.
Click here.	Click here.	Click here.	Click here.
Click here.	Click here.	Click here.	Click here.
Click here.	Click here.	Click here.	Click here.
Click here.	Click here.	Click here.	Click here.

How did you hear about us? (Please select): Choose an item. If Other: Click here to enter text.

Please Note: Upon completion of this form, please save it as a PDF with either your name and/or company name w/in the file name and email it back to info@provectusenv.com. Thank you for your interest in Provectus Environmental Products.