pro_req2

PROPOSAL REQUEST FORM

TO: Tom Frangella Strategic Environmental Solutions 1800 15th Sreet, Suite 203 Denver, CO 80202 303·572·1100 FAX·572·1106	FROM: NAME: ________________________________ COMPANY: ____________________________ ADDRESS: _____________________________ ______________________________________ TELEPHONE: __________________________ FAX: _________________________________
JOB LOCATION _________________________________________ _________________________________________ _________________________________________	SOIL VOLUME Tons:_________________________________ Yards:_________________________________
SOIL CONTAMINATED BY: ____ Underground Storage Tank (UST) ____ Aboveground Storage Tank (AST) ____ Surface Spill ____ Pipeline ____ Refinery ____ Other _______________________________	TPH VALUES: __________________________ BTEX VALUES: _________________________ OTHER: _______________________________ ________________________________________
SERVICES REQUESTED ____ Excavation ____ Loading ____ Transportation ____ Treatment/Recycling ____ Landfilling ____ Supply Backfill Material ____ Backfilling ____ All of the above ____ Other _______________________________	TIME FRAMES Proposal to be submitted by: _________________ Work to begin by: _________________________ Work to be completed by: ___________________ Please Respond to This Request via: ____ Fax ____ Mail ____ Verbal
PREFERRED TECHNOLOGY ____ CO-7 ____ Thermal ____ Bioremediation ____ Landfarm ____ Landfill ____ Asphalt Incorporation ____ All of the above if available ____ Other _______________________________	ADDITIONAL INSTRUCTIONS/REQUESTS ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________