BIOX® is a registered trademark of BMS, Inc.

Corporate Office BMS, Inc. 1692 Sunnyslope Drive Crown Point , IN 46307 T: (888) 477-0550 F: (219) 988-5923

PROJECT QUESTIONNAIRE FORM

The purpose of this questionnaire form is to begin developing an accurate and effective design for the application of the BIOX® Process at your site.  Upon receipt of the below form and supplemental information, BMS, Inc. will issue a quote depicting the parameters for treatment.

Consultant Information
	Name:
	Address:
	City:	State: -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
	Zip:
	Phone:
	Fax:
	E-mail:
	Contact(s):

Project Information
	Project Name:
	Project Location:
	Prior Remedial Activities:
	Site:	Active      Inactive

Required Site Information Check the boxes below if the site information is available.  Then either e-mail the additional information to biox@bioxtech.com, FAX the additional information to (219) 988-5923, or send via post to 1692 Sunnyslope Drive, Crown Point, IN 46307.
		Site Map, Groundwater Contour Map, & Groundwater and/or Soil Plume Map
		Soil Boring and Monitoring Well Logs within Treatment Area
		Historical Analytical Tables (BTEX, VOC, TPH, TOC, DOC, and Heterotrophic Plate Counts) for Soil and Groundwater Contamination
		Photos (if available)

Contaminant Information
	Contaminant(s):
	Product(s) Released:
	Source of Release:
	Contaminated Media:	Soil   Smear Zone    Groundwater
	NAPL's Present:	Yes     No
	Off-Site Contamination:	Yes     No
	Biofeasibility Conducted:	Yes     No

Subsurface Parameters
	Soil Type :
	Saturated Zone (ft.):
	Unsaturated Zone (ft.):
	Depth to GW While Drilling: (ft.):
	Depth to GW Static (ft.):
	Historical Groundwater Fluctuations (ft.):
	Areal Extent of Contamination (ft.):	by
	Vertical Extent of Contamination (ft.):	to
	Volume to be treated (yd³):

General Site Information
	Paved:	Yes     No
	Water:	Yes     No
	Electricity:	Yes     No
	Permits required:
	Please use the following space provided to include any additional information necessary for the assessment of this site:

	When the form is completed, click the SUBMIT button to send your project questionnaire to bioxtech.com:

You may also click here for a printable (PDF) version of the Project Questionnaire.

Print out the form and then FAX or mail it to:

BMS, Inc.
1692 Sunnyslope Drive
Crown Point , IN 46307
T: (888) 477-0550
F: (219) 988-5923
E-mail: biox@bioxtech.com