Client Agreement Form

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Agreement for Underground Tank Inspection Services

Pollard Environmental, LLC (“PE”) will attempt to perform a standard inspection of a petroleum underground storage tank at the below-listed property. The inspection consists of advancing soil borings adjacent to the tank as practicable using a hand auger. The depth of the borings is to be below the tank bottom, and soil samples are to be obtained and screened for volatile organic compounds (VOCs) using a Photo-Ionization Detector (PID). The soil sample exhibiting the highest VOC reading will be submitted to an independent laboratory for analysis of petroleum in the applicable hydrocarbon range. PE will interpret the results of the inspection in a brief narrative report to the client.

PE will exercise its best effort to inspect the tank. An inspection requires a visible and accessible fill pipe, vent pipe, or fuel supply/return line to enable location of the tank. Additionally, obstructions or subsurface conditions may render an inspection impracticable. If the inspection is unsuccessful, PE may refund some costs if not incurred during the attempted inspection. If obstructions or difficult access requires atypical measures to perform the inspection, additional costs may apply, but PE personnel will obtain approval from client prior to any change orders.

Project Fee:

County the Tank is Located

County:*

Would you like to add Accelerated Turnaround Time?
(7 Business Day Turnaround Time - $150)

Add ATT?*

Yes

Standard Inspection Fee
(10 Business Day Turn-Around Time)

Standard Inspection Fee Cost (Central VA):*

Standard Inspection Fee Cost (Tidewater):*

Standard Inspection Fee Cost (NoVA):*

Standard Inspection Fee Cost (Lynchburg):*

Standard Inspection Fee Cost (No Option Selected):*

Accelerated Turnaround Time
(7 business day turn-around time)

ATT Cost:

Please enter a number from 150 to 150.

Total Charge

Total Charge:*

Location of Tank on Property:

Property Address:

Client Billing Information:

(an invoice will be sent under separate cover; payment is due before we can issue our report; we accept online payment via VISA/MC credit cards)

Name:*

Address:*

Street Address Address Line 2 City State ZIP Code

Primary Email:*

Invoice Emailed?*

Yes

RE Agent Name:

RE Agent Phone:

RE Agent Email:

Include in all email correspondence?

Yes

Referred to Pollard Environmental by?