Recirculating Well Technology Design Data Form

Client

Date

Contact Person*

Phone

Project Name/Location

Fax

Email*

If possible, please include:
(Please e-mail separately to technicalagwr.com)

Site map showing source(s), monitoring wells

Yes No

Lithologic cross sections at right angles

Yes No

Map showing horizontal and vertical distribution of contaminants in vadose zone

Yes No

Map showing horizontal and vertical distribution of contaminants in saturated zone

Yes No

Well logs, test borings

Yes No

Treatment objective(s)

Contaminants of concern and their respective concentrations

Action levels for above contaminants

Describe plume dimensions & depths

Free product present? Thickness (ft)

LNAPLs / DNAPLs present?

Confined aquifer?

Yes

No
If yes, please describe

Saturated zone hydraulic conductivity

Anisotropic ratio

Depth to groundwater (ft bgs)

Seasonal variations in groundwater elevation

(ft)

Aquifer thickness (saturated depth) (ft)

Porosity

Plume thickness if less than saturated thickness (ft)

Hydraulic gradient (ft / ft)

Pump test results (gpm)

Groundwater temperature (^oC)

Dissolved iron (ppm)

Total iron (ppm)

Other inorganics of concern (ppm)

Calcite precipitation potential for DDC (alkalinity, calcium, total dissolved solids, temperature, pH)

Off gas treatment requirements

Other relevant information

Fax:	(541)-757-7706
Telephone:	(541)-757-7700
E-mail:	technicalagwr.com
Regular mail:	2851 NW 9th Street Suite D Corvallis, OR 97330