GeoSolve Division
VENTURE ENTERPRISES
1723 Verrazzano Drive Wilmington, NC 28405

REMEDIATION SITE CANDIDATE DATA SHEET
For Technical Assistance, Please Call: Ron Vigneri 910-297-9908 Fax completed form to: 910-256-5232
or copy & paste into word processor and email to [email protected]
Note: Items marked * and bolded must be provided.

*Site Name or ID:_______________________________________ Date:______________________
*General Contractor:________________________________________________________________
*GC Contact: __________________________________*Phone: ___________Fax:______________
State Regulatory Agency:__________________Case Manager:_________________________________
*Remediation Location/Job Site:_______________________________________________________
__________________________________________________________________________________
Owner Name & Address:______________________________________________________________
*Project Contact Name:_____________________________Title:_____________________________
*Address: _________________________________________________________________________
*Phone: ______________________________ Fax: _________________________________________
*Remediation Property Description:____________________________________________________
Town___________________ County__________________ Lot_____ Block______
Size: ________________ acres, or sq. ft. Shape:____________________ square/rectangle/irregular.
Ground Elevation Profile: ___________flat, sloped, mixed ? Special Features:___________________
Present Use: _________________________Former Use:___________________________________

WATER DATA
Type: ______________________________groundwater/leachate/well/pond/potable
* pH: _________*@ Temperature _________deg F / C (circle) *ORP _________millivolts (Eh)
* Free Product___________________type/LNAPL/DNAPL (amount and description, if present):
__________________________________________________________________in - or - gal
* Specific Conductance__________ mS/cm Salinity_________ ppm TDS______________ ppm
* Contaminants (list): ______________________________concentration_________(circle ppm or ppb)
Metals: (circle ppm or ppb) Iron ____________ppm - or - ppb Lead_________________ppm - or - ppb
Other________________________________ppm - or - ppb Other_________________ppm - or - ppb
MTBE____________ ppm - or - ppb
Carbonates (CaCO3): ___________________ppm Hydroxyl Scavengers: YES or NO (circle one)
Sulfates: ___________________ppm
*Total Organic Carbon in Water:_______________________ ppm
*Contaminants list with max. concentration (circle concentration measurement unit):
__________________________________________ppm - or - ppb present in Well Nos._________________________________
__________________________________________ppm - or - ppb present in Well Nos._________________________________
__________________________________________ppm - or - ppb present in Well Nos._________________________________
__________________________________________ppm - or - ppb present in Well Nos._________________________________
__________________________________________ppm - or - ppb present in Well Nos._________________________________
__________________________________________ppm - or - ppb present in Well Nos._________________________________

* Data Attached (circle one): YES NO Circle: MTBE; BTEX; VOC+; SVOC; Base Nuetral; Pesticide

* Monitoring Wells / Piezometers
No._____Diam.__in. Depth___ft. Screen From___to___ft. | No._____Diam.__in. Depth___ft. Screen From___to___ft.
No._____Diam.__in. Depth___ft. Screen From___to___ft. | No._____Diam.__in. Depth___ft. Screen From___to___ft.
No._____Diam.__in. Depth___ft. Screen From___to___ft. | No._____Diam.__in. Depth___ft. Screen From___to___ft.
No._____Diam.__in. Depth___ft. Screen From___to___ft. | No._____Diam.__in. Depth___ft. Screen From___to___ft.
No._____Diam.__in. Depth___ft. Screen From___to___ft. | No._____Diam.__in. Depth___ft. Screen From___to___ft.

* Water Depth: __________feet to contact through ___________feet to the bottom (range).
* Flow Rate: _______________ feet per day
* Aquifer/Reservoir Description: ______________________________________________________

SATURATED MATRIX / SOIL DATA
Saturated Matrix type or Classification:____________________________________________________
Remarks:__________________________________________________________________________
* Attach copies of all hydrogeology data, site plans, well location map and groundwater contour drawings available.
* Porosity:____ % *Permeability w/units________ -or- Hydraulic Conductivity w/units____________
Lithology(ies)_______________ Petrology________________ Size Fractions______________________
Sorting, Color, Odor__________________________________________________________________
Carbon Content _____% Moisture Content_____ % Organic Content_____ %
Saturated Zone Depth________ ft. top to _______ft. bottom Ground Elevation amsl ________________ft
* Remediation objectives, cleanup levels and other comments:______________________________
__________________________________________________________________________________

* Prepared by: ________________________Title____________ * Submission Date:_____________
* Company:_______________________________________* Phone: _________________________

Bench Test Sample Instructions: After a GEMS design has been completed,water samples (and matrix materials) should be forwarded
to the above listed GeoSolve address. Process application steps are staged: analysis & design, bench test, pilot test, and full remediation.
Thank you for your submission and interest in the GeoSolve Process, a proprietary state-of-the-art advanced chemical oxidation process.
©2004 By Venture Enterprises, All Rights Reserved. This Site Candidate Sheet may be reproduced for submission to the GeoSolve Division.

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