STATE: ____________
|
a.) |
By contaminant |
|
b.) |
By industry |
|
c.) |
By geographical area |
|
d.) |
By media impacted |
|
e.) |
Other, explain |
Soil?
Ground water?
|
a.) |
forbid |
|
b.) |
allow |
|
c.) |
encourage |
|
d.) |
require |
|
a.) |
forbid |
|
b.) |
allow |
|
c.) |
encourage |
|
d.) |
require |
Soil?
Ground water?
Surface water?
Petroleum-impacted sites?
Non-petroleum-impacted sites?
|
a.) |
no familiarity |
|
b.) |
a little familiarity |
|
c.) |
some familiarity |
|
d.) |
very familiar |
Current conditions?
Future conditions?
|
a.) |
at case activation |
|
b.) |
prior to setting cleanup levels |
|
c.) |
anytime, but prior to case closure |
|
d.) |
not required |
To be completed by the person who completed this survey:
Name:
Title:
Affiliation:
Telephone No.:
Date: