School and Daycare Field Sheets O'Connor, Danny to ... School and Daycare Field Sheets O'Connor,...
Transcript of School and Daycare Field Sheets O'Connor, Danny to ... School and Daycare Field Sheets O'Connor,...
_ School and Daycare Field Sheets O'Connor, Danny to: Heath Smith, Jason Gunter
1 attachment
11/16/2010 01:09 PM
School and Daycare Field Sheets.pdf
Attached are the field sheets for the schools and daycares sampled by START in St. Francois County. There should be 11 schools and 17 daycares. Let me know if you have1 questions, thanks.
Schools: BR-0001 through BR-0011 Note: For BR-0010 "Special Acres State School" you will have to
contact Bob Self with the Missouri Administrators Office, his number is on the back of the field sheet.
Daycares: BR-0012 through BR-0027, and BR-0031
Danny O'Connor | Environmental Scientist
806 Horan Drive I Fenton, Missouri 63026 I www.tetratech.com Direct: | Cell: | Fax:
Tetra Tech | Complex World, Clear Solutions(tm)
PLEASE NOTE: This message, including any attachments, may include privileged, confidential and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient is strictly prohibited and may be unlawful. If you are not the intended recipient, please notify the sender by replying-to this message and then delete it from your system.
Property ID: o o & \
School Name: A0o>4K P^rLstclc. EUn\<LAba.ry
Address: loo Morli* P^U-ilde- ~Deslcg&,fAo
Sample Area Pre Ex XXX Sample Area Post Ex (XXX)
Cell 1 53.5 Cell 13 1671 . Cell 25 175
Cell 2 £20 Cell 14 H.67 Cell 26 7L3.
Cell 3 (o03 Cell 15 L°13 Cell 27 1310
Cell 4 S^O Cell 16 I Cell 28 1417
Cell 5 7Sir-. Cell 17 mi Cell 29 54 i
Cell 6 5 4 4 Cell 18 3 1 5 3 Cell 30 548
Cell 7 U , 4 \ Cell 19 38£o~l- Cell 31 2773
Cell 8 7?,?3 Cell 20 3 I 3 U Cell 32 L7&
Cell 9 757 Cell 21 1253 Cell33 773
Cell 10 737 Cell 22 LOS Cell34 L 3 1
Cell 11 £ 5 3 Cell 23 549 Cell 35 i Z L Z .
Cell 12 857 Cell 24 3 L 3
St. Francois County RSE
Screening Form
Post
North Arrow
Pre Ex Samples Collected
Initials: Do, (-&, KF,6P Date: lo- -10
T i m e : ISoo
Pre Ex Samples Analyzed
Initials: "Po Date: jc - 2.S - i O Time: OSCO
Sample Area Pre Ex XXX Sample Area Post Ex OQQO
Pre Post Pre Post Pre Post TH-1(0-6") Kit TH-2 (0-6") TH-3 (0-6") i44z
TH-1 (6-12") j 2. 4 TH-2 (6-12") 7l7 TH-3 (6-12")
TH-1 (12-18")_^5S TH-2 (12-18") 3O(o TH-3(12-18") IZC
TH-1 (18-24") 22.10 TH-2 (18-24") 3.17 TH-3 (18-24") 4i
TH-4 (0-6") &9L TH-5 (0-6") 2-774 TH-6 (0-6") ^ZoZ. _
TH-4 (6-12") <\Z TH-5 (6-12") . TH-6 (6-12") 2^62
TH-4 (12-18") TH-5 (12-18") 2.358 TH-6(12-18") 135k
TH-4 (18-24") n-7 TH-5 (18-24") 72fe TH-6( 18-24") 77fe
TH-7 (0-6") 7 lo\ TH-8 (0-6") 11S<*. TH-9 (0-6") —
TH-7 (6-12")_3T3_ TH-8 (6-12") £74^ TH-9 (6-12") —
TH-7 (12-18") HUCf TH-8 (12-18") l 48L TH-9(12-18") ~
TH-7(18-24") t in TH-8(18-24") |g TH-9( 18-24") -
Property ID: OOOI School District
}0oi.4k -Si. Francois Co^4^ P--1 Owner Information (if different from front)
Superintendent Name & No. Pcat-maSi £73-358-3^^7 Circle one: CelK^ork)
Principal Name & No. Javid- Mrv-.iL. 573- 431 - 33oo Circle one: Cell^ojjl
Other Contact Name & No.D,'^ Uvr-^y\c.\/e.r Circle one:€Stl Work
School Address: LOO WORTH PA.RU.SIDE. STREET- City & Zip: -pfts/o^e ; Mn L3Q.O I
Mailing Address: Sa-rAt. Attn:
City, State: Zip:
Physical Description of House or Property (include age of school if known)
MiuJ Sckooi FAA\ O4 3LO 10
of Ock £WE.E.\'/ t«s+ 0"P F>C*-RLUS 1 clt. 5Vre-£f
GPS Coordinates: Latitude 3-7. g7,1 2 2. Longitude - <] D. 63 0 C73
Does this property have a private drinking water well? Yes (TStyVKate? Other:
Number of Students:
Approximate age range:
Is the well shared by another property: _ Property ID: _
Groundwater sampling location: —
Depth of well: — Treatment system in use? — Type (filter, softener,etc.:) —
Date Access to Screen Granted: I O ~ 4 - L O
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected, ect...):
Property ED: OOQSL
School Name: Mo»-^ ivAerwverlialE SckooiSt. Francois County RSE
Address: Elyv> sWaA "De&ione. M.O Screening Form CJ 1 ~ isilzCX
Sample Area Pre Ex XXX
Pre Cell 1 J2Cs>3_
Cell 2
Cell 3 3T*I
Cell4 I"35
Cell 5
Cell 6 7-2.<7
Cell 7 _|_jL5
Cell 8_[4k_
Cell 9
Cell 10 lA°lS
Cell 11 JJ32.
Cell 12 152.
Post
Sample Area Post Ex (XXX)
Pre Post Cell 13 37o
Cell 14 g/5
Cell 15 <fTg
Cell 16 9<0?
Cell 17 //&9
Cell 18
Cell 19 loOQ
Cell 20 3L<aC
Cell 21 38\
Cell 22 IP2.2.
Cell 23 L
Cell 24 J 32-
Pre Cell 25
Post
Cell 26 JoS
Cell 27 13 i
Cell 28 i 31
Cell29 i3g
Cell 30 l'2-4
Gravel Area 1
Gravel Area 2
Gravel Area 3
Gravel Area 4
Gravel Area 5
Gravel Area 6
_25_
North Arrow
• Pre Ex Samples Collected
Initials:-QP,-p 6 (g-F" D a t e : j a - t j -m Time: / 2.^/0
Pre Ex Samples Analyzed
Initials: TXP Date: i q - 2 .6 -IO Time: <042JO
Gravel Area 7
Gravel Area 8 IG
Play Area 1 j"2.3
Play Area 2 Hfc
Play Area 3 i~2.l
Sample Area Pre Ex XXX Sample Area Post Ex (XXX)
Pre Post Pre Post Pre Post TH-1 (0-6") 11% TH-2 (0-6") I GO TH-3 (0-6")
TH-1 (6-12") lG03 TH-2 (6-12") TH-3 (6-12") VSS
TH-1 (12-18") (o(o TH-2 (12-18") Z(e> TH-3(12-18") ZOO
TH-1 (18-24") TH-2 (18-24") jJ3> TH-3(18-24") 4g __
TH-4 (0-6") I CF\ TH-5 (0-6") 154 TH-6 (0-6") I Q i {
TH-4(6-12")_25_ TH-5 (6-12") 74 TH-6 (6-12") 24
TH-4 (12-18") 34 TH-5 (12-18") 32 TH-6(12-18") 44
TH-4 (18-24") _53_ TH-5 (18-24") 2JO TH-6(18-24") 34
TH-7 (0-6") 24 TH-8 (0-6") 76 TH-9 (0-6") tig
TH-7 (6-12") 37 TH-8 (6-12") 4S" TH-9 (6-12") IS
TH-7 (12-18") 33 TH-8 (12-18") t fz TH-9Q2-18") joo
TH-7 (18-24") _39_ TH-8(18-24")_7j TH-9( 18-24") $3 TH-10(0-6") a 4l TH-11 (0-6") Jl£ TH-12(0-6") i Z I
TH-10 (6-12") 324 TH-11 (6-12") 7<? TH-12 (6-12") 5*?
TH-10 (12-18") 334 TH-11 (12-18") 32. TH-12(12-18") <oL>
TH-10 (18-24") 132. TH-11 (18-24") TH-12(18-24") l2.<^
Property ID: OOG3-> School District
AWAK St . F
Owner Information (if different from front) Superintendent Name & No. fWyvum £"7 3 - 3f?g - -yy.Ai- Circle one: Cell Woffc)
Principal Name & No. Seo^le- 5"f 3 - 431 - 13SS* Circle one: Celk^orR)
Other Contact Name & No. 5*73-431 - (o^Sz. Circle one: Cell ork)
School Address: ^ City & Zip: ~D>e<=, \ oy. , tup
Mailing Address: tfo I El ^ Street- Attn:
City, State: : Zip:
Physical Description of House or Property (include age of school if known)
/Ook-AVv of S+vdeT £o_st- o-f /Oor+h cJitson Streex
GPS Coordinates: Latitude 3-f gji]7 n Longitude - <?o. 5 i 4,003-
Does this property have a private drinking water well? Yes <<? "Wateb Other:
Number of Students: 122.
Approximate age range: IO - l\
Is the well shared by another property : _ Property ID: —
Groundwater sampling location: _
Depth of well: — Treatment system in use? _ Type (filter, softener,etc.:) —
Date Access to Screen Granted: jo - 4 - l£>
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected, ect...):
Property ID: ooo 3
School Name: Coi Pr\ St. Francois County RSE
Address: Ho5 KiUc^f "Drive. T>.-.-e-, Mo Screening Form
Sample Area Pre Ex XXX
Pre Post Cell 1 1 1 3
Cell 2
Cell 3 3 .6 ,3
Cell4 3 \L
Cell 5 10 7
Cell 6 346,
Cell 7 333
Cell 8 Iff 7
Cell 9 3 .14
Cell 10 i4a Cell 11 _L%£_
Cell \2 J3a ;
Sample Area Post Ex (XXX)
Cell 13
Cell 14
Cell 15
Cell 16
Cell 17
Cell 18
Cell 19
Cell 20
Cell 21
Cell 22
Cell 23
Cell 24
Pre •3/7 3.53
3 S j
3 4O
m
34o
3°lo
16,0
m
345
371
314
Post Pre Cell 25 $58
Cell 26 314
Cell 27 31<=\
Cell 28 3\U
Cell 29 36,4
Cell 30 114
Cell 31 134
Cell 32 JO?
Cell 33 !5o
Cel l 34 lo i
Cell 35 154
Gravel Area 1
Post
13
North Arrow
Pre Ex Samples Collected
Initials: "Do 4 15T D a t e : l o - p - t o Time: oftSQ
Pre Ex Samples Analyzed
Initials: "Do Date: /Q- a? - to Time: f)^5o
Gravel Area 2 l4
Gravel Area 3 Zo
Gravel Area 4 35
Sample Area Pre Ex XXX
Pre TH-1 (0-6") 344
TH-1 (6-12") 5V)
TH-1 (12-18") L{31
TH-1 (18-24") \u0
TH-4 (0-6") 3o\
TH-4 (6-12") 341
TH-4 (12-18") 772-
TH4 (18-24") 3 In
TH-7 (0-6") API
TH-7 (6-12") 111
TH-7 (12-18") I 73
TH-7 (18-24") If. 7
TH-10 (0-6") 353
TH-10 (6-12") 3 \g
TH-10 (12-18") 36 ,3
TH-10 (18-24") 444 _
Sample Area Post Ex (XXX)
Post Pre Post TH-2 (0-6") /3o
TH-2 (6-12") 215
TH-2 (12-18") |qq
TH-2 (18-24") 351
TH-5 (0-6") 3M3
TH-5 (6-12") 34L
TH-5 (12-18") 4x4 TH-5 (18-24") 4U1
TH-8 (0-6") &52> '
TH-8 (6-12") 3g<?
TH-8 (12-18") 323
TH-8 (18-24") 4lZ
TH-11 (0-6")
TH-11 (6-12") 3Zg
TH-11 (12-18") afffe
Pre TH-3 (0-6") 331
Post
TH-11(18-24") 737
TH-3 (6-12") 1U5
TH-3(12-18") 31
TH-3(18-24") 345
TH-6 (0-6") 3OO
TH-6 (6-12") 313
TH-6(12-18") 35 A
TH-6( 18-24") 3lO
TH-9 (0-6") 2-OU
TH-9(6-12") I f?6 ,
TH-9(12-18") 1
TH-9( 18-24") i zz .
TH-12 (0-6") 184
TH-12 (6-12") 131
TH-12(12-18") I (el
TH-12(18-24") 156
Property ID: 000 3 School District
Owner Information (if different from front) -Superintendent Name & No. cuo 573 - 35?-3.2.^7 Circle one: CelKfflorlQ
Principal Name & No. E-oijWLyA fWV,vw&vt 57.^ - 35?- on Circle one: Cell^orR)
Other Contact Name & No. T)\<a.ne Schoonovtr Circle one: Cell Work
School Address: 4o5 Hillc>-e5* "D-i^e- City & Zip: "So^e. T*.rre. ;n\o (a3t,aB
Mailing Address:^ Attn:
City, State: Zip: . •
Physical Description of House or Property (include age of school if known)
"Torn t If d v ' Vp f*roir*1 Sctioo/ locz-kd
Oorth si'de. af roa^j.
GPS Coordinates: Latitude 3-^ ° \ \~f~}5 '3 Longitude - c^Q % 2. 111? 8
Does this property have a private drinking water well? Yes cCity WateP^Other:
Number of Students: g f0
Approximate age range: 5 - 8
Is the well shared by another property: Property ED: —
Groundwater sampling location: _
Depth of well: _ Treatment system in use? _ Type {filter, softener,etc.:) —
Date Access to Screen Granted: lo - M - 10
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected, ect...):
Property ID: ooc>*\
School Name: AJQVUX Middle. Sokooi St. Francois County RSE
Address: 4ok £"a.si- CkesfrKiui- "Iteslocje, MO Screening Form
North Arrow
Sample Area Pre Ex XXX
Pre Post Cell 1 m
Cell 2 152.
Cell 3 4o9
Cell 4 / n i l
Cell 5 95<b
Cell 6 _____
Cell 7 297
Cell 8 _2S33—
Cell 9 4SH
Cell 10 4c2.
CeU 11
CeU 12 12.52.
Sample Area Post Ex (XXX)
Pre Post CeU 13 HsMS
CeU 14 f(?C
CeU 15 19S
CeU 16 S3 i
CeU 17
CeU 18 7.^
CeU 19 23Z5
CeU 20 HIS
Cell 21 /337 1
CeU 22 HH3
CeU 23
CeU24 5/4
Pre Post CeU 25 llZie
CeU 26 J52.H
Landscape
Pre Ex Samples Collected
Initials: ^ 6rP D a t e : \ n - L - \ P Time: d23q
Pre Ex Samples Analyzed
Initials: 3 M Date: Time: l3o O
Samnle Area Pre Ex XXX Sample Area Post Ex (XXX)
Pre Post Pre Post Pre Post TH-1(0-6") 315? TH-2 (0-6") MZI TH-3 (0-6") Jte>J
TH-1 (6-12") 8H5 TH-2 (6-12") Wok TH-3 (6-12") 134
TH-1 C12-18") TH-2 (12-18") 17h TH-3(12-18") °iio
TH-1 (18-24") 43 TH-2 (18-24")£"S TH-3(18-24") \Z.-Z>
TH-4 (0-6") 53 4 TH-5 (0-6") TH-6(0-6") H k b
TH-4 (6-12") d 2 TH-5 (6-12") 331 TH-6(6-12") 921
TH-4 (12-18") 118 TH-5 (12-18") 463 TH-6(12-18")l43l
TH-4 (18-24") TH-5 (18-24") HI TH-6( 18-24") \%°l-7 .
TH-7 (0-6") Mzi TH-8 (0-6") -
TH-7 (6-12") 255 TH-8 (6-12") -
TH-7 (12-18") 2 14 TH-8 (12-18") -
TH-7 (18-24") TH-8 (18-24") -
I
Property ED: OO O^-j School District
<54. FVcinc&i's CBVIN-HI F^~ I 1+M
AAIN Owner Information (if different from front) Superintendent Name & No. V<a.y\ccj "PcaorwtfcH £73 -Igg- 2.2.47 Circle one: CellCffiD
Principal Name & No. Ma-die^j 573-43i- fc7QO Circle one: CellQ&Afr&
Other Contact Name & No."Di«.ng. f?7-?-6>3i - 6-432. Circle one: CelpWorE*
School Address: *loc eTojsV Chf_s+^u4 • City & Zip: "Dei lo^e.[ haq £=>3fcol
Mailing Address: 5>o.>v\t. a.s Attn:
City, State: Zip:_
Physical Description of House or Property (include age of school if known)
I OC.AJ-&d b^.A:UJ«.0-v HjOrVV>, Sc.V%oo\ I KJov-VV^ Wa.v-eiv\g . Sol»"H-\ CRC £T<ajS-V
GPS Coordinates: Latitude 3-7 g-y j£50 Longitude - <)o. 5 2|qelo
Does this property have a private drinking water well? Yes CCIty Watefc Other:
Number of Students:
Approximate age range: | 3 - |
Is the well shared by another property: _ Property ID:
Groundwater sampling location:
Depth of well: Treatment system in use? Type (filter, softener,etc.:) -
Date Access to Screen Granted: 10-4-10
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected, ect...):
Property ID: ooo5-
School Name: Coi».i/vVi4 •5e.v\ior HiaV\ Sc-kool St. Francois County RSE North Arrow
Address: 7151 -J
1Z.eae\<.V J
Z.£>£ic) dorung. Terre.. 1wn Screening Form
Samnle Area Pre Ex XXX
Pre Post Cell 1 IOO
Samde Area Post Ex (XXX)
Pre Post Cell 13 293
Pre Post Cell 25 92
Pre Ex Samples Collected
Initials: JP 4 &T> Date: lo - 5 - IO
Cell 2 79 Cell 14 485 Cell 26 22 o4 Time: O8Z0
Cell 3 log Cell 15 478 Cell 27 z4o8 Pre Ex Samples
Analyzed Initials: Rr4 Cell 4 95 Cell 16 Cell 28 2635
Pre Ex Samples Analyzed
Initials: Rr4
Cell 5 97 Cell 17 <234. Cell 29 33o4 Date: in- 2.0-la Time: o°loo
Cell 6 94 Cell 18 US9 Cell 30 jf„81 Cell 6 94 Cell 18 US9 Cell 30 jf„81
Cell 7 zz4 Cell 19 265 1
Cell 31 Izqi
Cell 8 i4f?z Cell 20 23© Cell 32 lo,
Cell 9 95 Cell 21 56 Cell 33 81
Cell 10 loi,4 Cell 22 437 Cell 34 /77
Cell 11 5ss Cell 23 2 6,0 Cell 35 .36©
Cell 12 m Cell 24 /963 Cell 36 351
Samnle Area Pre Ex XXX Sample Area Post Ex (XXX)
Pre Post Pre Post Pre Post TH-1 (0-6") 72 TH-2 (0-6") 3L5 TH-3 (0-6")
TH-1 (6-12") 71 TH-2 (6-12") £797 TH-3 (6-12") 37
TH-1 (12-18") 54 TH-2 (12-18") 793 TH-3(12-18") 43 TH-1 (18-24") /02 TH-2 (18-24") 133 TH-3( 18-24") ?2-
TH-4 (0-6") 523 3 TH-5 (0-6") 44 TH-6 (0-6") 69
TH-4 (6-12") 5*2© TH-5 (6-12") 55 TH-6 (6-12") Ln
TH-4 (12-18") .392. TH-5 (12-18") .36 TH-6(12-18") 57
TH-4 (18-24") 112 TH-5 (18-24") 46 TH-6( 18-24") 52-
TH-7 (0-6") 5 2 TH-8 (0-6") 84 TH-9 (0-6") 99
TH-7 (6-12") 42- TH-8 (6-12") 79 TH-9 (6-12") 6/
TH-7 (12-18") 4C, TH-8 (12-18") 65 TH-9(12-18") Ia4 TH-7 (18-24") 4l TH-8 (18-24") TH-9( 18-24") 444 TH-10 (0-6") 19. TH-11(0-6") -
TH-10 (6-12") |37 TH-11(6-12") - P TH-10 (12-18") 91 TH-11 (12-18") -
TH-10 (18-24") /16 TH-11 (18-24") -
Property ID: OOO^ School District
|0o^k Si. rrti-ftCa^ Co• \
Owner Information (if different from front) Superintendent Name & No. Pno«-wia.n 573 - ZS8-2.2. Hi Circle one: CelCWork)
Principal Name & No. JqIavn QsabWee. S i3 - 3S 8- - gg7<o Circle one: Celky/orfl
Other Contact Name & No. t> UotvAoaa, 573 - 6>3 i - I2- Circle one: Celf$&eri£
School Address: 7151 Rq-»c1<lV Eoo_j City & Zip: Tt.>-r<. , Mo 2.#
Mailing Address: .5 &.wrt« ^ Attn:
City, State: Zip:
Physical Description of House or Property (include age of school if known)
5oo+W of" o\c1 o^c-Ko.^d Htoy (of
GPS Coordinates: Latitude 37 Cjogotc Longitude - 5 2.-c) 0 3 |
Does this property have a private drinking water well? Yes CjQity \#ater^ Other:
Number of Students:
Approximate age range: j 5 - 1 ?
Is the well shared by another property: - Property ID: _
Groundwater sampling location: _
Depth of well: - Treatment system in use? _ Type (filter,.softener,etc.:)
Date Access to Screen Granted: lo - 4 - 10
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected, ect...):
Property ID: OOOC*
School Name: Da i \e.c. Cciveer Ce.v\\-ev St. Francois County RSE North Arrow
Address: 7l&>3 (2-a.idev V-ooA Bon e. Tc^re.. M.O Screening Form
Sample Area Pre Ex XXX
Pre Post Cell 1
Sample Area Post Ex (XXX)
Pre Post Cell 13 /4?
Pre Ex Samples Collected
Initials: "Do T>6 (£ F D a t e : l o - S - l o
Cell 2 Cell 14 l4o Time:
Cell 3 758 Cell 15 /22 Pre Ex Samples
Analyzed Initials: "Vo Cell 4 751 Cell 16 127 i
Pre Ex Samples Analyzed
Initials: "Vo
Cell 5 5W4 Cell 17 113 Date: || - 1 - to Time: o^So
Cell 6 <??? Cell 18 \o5 Cell 6 <??? Cell 18 \o5
Cell 7 Cell 19 \2<\
Cell 8 Szo Gravel Area 1 132.
Cell 9 73o Gravel Area 2 Z(a
Cell 10 /45k
Cell 11 4>77
Cell 12 437
Sample Area Pre Ex XXX Sample Area Post Ex (XXX)
Pre TH-1 (0-6") 57
TH-1 (6-12") MO
Post
TH-1 (12-18") 5"f
TH-1 (18-24") 4/
TH-4 (0-6") 12 Z
TH-4 (6-12") lO
TH-4 (12-18") 1L
TH-4 (18-24") <o2
Pre TH-2 (0-6")
TH-2 (6-12") 74
TH-2 (12-18") SC,
TH-2 (18-24") 44
TH-5 (0-6")
TH-5 (6-12") Lie
TH-5 (12-18") 38
TH-5 (18-24") 238
Post Pre TH-3 (0-6") 73
TH-3 (6-12") 7?
TH-3(12-18")
TH-3(18-24") Ln
TH-6 (0-6") 477
TH-6 (6-12") 317
TH-6(12-18") 154
TH-6( 18-24") \oz__
Post
Property ID: School District
Owner Information (if different from front) Superintendent Name & No. Poornaan 57V 35#- 2-2-4 *7 Circle one: Cell S^or$
Principal Name & No. tj 573-358- 3271 Circle one: Cell^orD
Other Contact Name & No. "D> j ScWoo^ov/c-r- 573 - fc31 - M ?2- Circle one: Cell^ork^
School Address: 7lk>3 City & Zip: "Rot-v-Ng. Te^e. , Mo
Mailing Address: A w a. <LS Attn.
City, State:_ Zip: :
Physical Description of House or Property (include age of school if known)
SouVi^uJesl- of Old OvctMxwJ e*»V 1W>-) (el. OkI(-c.c •Sl<3'^
froiA.V of build I
GPS Coordinates: Latitude 37. cjcf\-2.e\'b Longitude _ °|0. 5 2.0,534
Does this property have a private drinking water well? Yes (C ity WateP) Other:
Number of Students: f
Approximate age range: 1 5 - 1 8
Is the well shared by another property: - Property ID: —
Groundwater sampling location: —
Depth of well: - Treatment system in use? _ Type (filter, softener,etc.:) —
Date Access to Screen Granted: !o ~4 - io .
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected, ect...):
1
Property ID: qoo^
School Name: uJes-V E \*.w\e.\/\\-oyn .ScW-ocal St. Francois County RSE North Arrow
Address: 4o3 O
L0eS+ fiVg. Po-yU. 4.'ils,^Screening Form 4.'ils,^Screening Form
Sample Area Pre Ex XXX
Pre Post Cell I 1365
SamDle Area Post Ex (XXX)
Pre Post Cell 13 8So
Pre Ex Samples Collected
Initials: Date: ! o - C- jo
Cell 2 /664
Cell 3 433
Cell 4 1112.
Cell 14 /687
Cell 15 5765
Cell 16 1416
Time: l33o
Pre Ex Samples Analyzed
Initials: 2M
Cell 5 2-4 38 Cell 17 25 SO Date: I n - Z o - l O Time: (6oo
Cell 6 484 Cell 18 3.53-1 Cell 6 484 Cell 18 3.53-1
Cell 7 343 Cell 19 721
Cell 8 6,64 Cell 20 23 86
Cell 9 L?4 Cell 21 76 5
Cell 10 64 Cell 22 526
Cell 11 480 Play Area 1 Jo42
Cell 12 .317 Play Area 2 531 • •
Sample Area Pre Ex XXX Sample Area Post Ex (XXX)
Pre Post Pre Post TH-1 (0-6") .386 TH-2 (0-6") 2732-
Pre Post TH-3 (0-6") 437
TH-1 (6-12") Zoo ~ TH-2 (6-12") 45 L TH-3 (6-12") 134
TH-1 (12-18") 16 TH-2 (12-18") 72 TH-3(12-18") 30
TH-1 (18-24") 14 1 TH-2 (18-24") 31 TH-3(18-24") 26
TH-4 (0-6") .4 % TH-5 (0-6") 2.13 TH-6 (0-6") 364
TH-4 (6-12") 184 TH-5 (6-12") 45 TH-6 (6-12") 885"
TH-4 (12-18") 4S TH-5 (12-18") 3o\ TH-6(12-18") 11721
TH-4 (18-24") (nO TH-5 (18-24") 41 TH-6( 18-24") .522
TH-7 (0-6") J732
TH-7 (6-12") 2435 '•
TH-7 (12-18") 337
TH-7 (18-24") 1\2\
•
Property ID: School District
denGo.! 12 - m Owner Information (if different from front)
Superintendent Name & No. ~p<?.s'» Circle one: Cell Worl5
Principal Name & No. ike. j-B-, fofnow 573-^-31- 2m> 16. Circle one: Cell ^pxE>
Other Contact Name & No. ; Circle one: Cell Work
School Address: 4o3 1»V SVe-e-V City & Zip: 1\rv. Ifills rAo
Mailing Address: Sco^e. *-S oJoovg, Attn:
City, State: Zip:
Physical Description of House or Property (include age of school if known)
5ov+k of fUt 6 VvtfcV c.o-5^ 0{ Uorl-k UcvUo+ Sir-ceJ-
GPS Coordinates: Latitude 37 ?31-7^j Longitude _ cjQ SzlSSo
Does this property have a private drinking water well? Yes (^{fyWater^Dther:
Number of Students:
Approximate age range: ^ - |o
Is the well shared by another property: __ Property ID: _
Groundwater sampling location:
Depth of well: Treatment system in use? — Type (filter, softener, etc. :)
Date Access to Screen Granted: 10 - •M - lo
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected, ect...):
Property ID: 0008
School Name: f,g.y\WI 6~le.iwevt.Wj -SoKcnl St. Francois County RSE
Address: S-V. ypjY "Wc [Klls,^0 Screening Form
Sample Area Pre F-x XXX
Pre Post
Sample Area Post Ex (XXX)
Pre Post Pre
Cell 1 2612. Cell 13 456 Cell 25 I5 i
Cell 2 32 2. Cell 14 / 637 Cell 26 /65
Cell 3 2 58 Cell 15 176*1 Cell 27 246
Cell 4 1 64 Cell 16 iSog Cell 28 /2 82.
Cell 5 1 236 Cell 17 mi Cell 29 \U>\
Cell 6 314 Cell 18 in i Cell 30 ISO
Cell 7 237 Cell 19 123 Cell 31 36?
Cell 8 Cell 20 / I t Cell 32 65?
Cell 9 lt?°l Cell 21 3 oL Cell 33 535
Cell 10 Zool Cell 22 lot Cell 34 I I Z 9
Cell 11 1646 Cell 23 32.6 Cell 35
Cell 12 l(nOl Cell 24 /o6 Cell 36 667
Post
North Arrow
Pre Ex Samples Collected
Initials: 2D>o 2 fcE Date: lo-~7- Io Ti me: IZ.OO
Pre Ex Samples Analyzed
Initials: RM Date: lo/tj?/l<o Time: l<*QO
Sample Area Pre Ex X X X Sample Area Post Ex OOOO
Pre Post Pre Post Pre Post Cell 37 115 Cell 49 456 Play Area 3 644
Cell 38 Cell 50 Z I Z Play Area 4 546
Cell 39 1 26 \ Cell 51 315 Play Area 5 326
Cell 40 624 Cell 52 Zo Play Area 6 47
Cell 41 / 223 Cell 53 545 Plav Area 7 2.6
Cell 42 / 474 Cell 54 44? Pile _
Cell 43 112- Cell 55 441
Cell 44 Cell 56 S?4
Cell 45 171 Cell 57 7?
Cell 46 34? Cell 58 464
Cell 47 $0 Play Area 1 247
Cell 48 13/ Play Area 2 IZlZ
Property ID: School District
Owner Information (if different from front) Superintendent Name & No. T)es> AA<*-y b i r ry 5*73 - 431 -Z&12. Circle one: Celltffiorp
Principal Name & No. Circle one: Cell Work
Other Contact Name & No. Circle one: Cell Work
School Address: tfoo ST. Sh-t.e / City & Zip: P^U- jhlls , /ko Y„3fcQ)
Mailing Address: Attn: . .
City, State: Zip: •
Physical Description of House or Property (include age of school if known)
O f ? cuacI of US 67 business , -
GPS Coordinates: Latitude 37 Longitude -<fo.52732l
Does this property have a private drinking water well? Yes CC itv Wafalr Other:
Number of Students: 5Uo <
Approximate age range: ( 5 - 7 )
Is the well shared by another property: — Property ID: --
Groundwater sampling location: " 1
Depth of well: Treatment system in use? Type (filter, softener,etc.:) __
Date Access to Screen Granted: jo -4 - to
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected, ect...):
/
Property ID: ooo^
School Name: CmWaA 5CKOQ\
Address: UG, fc-e-beA ~pf\ve. Pc^L- 1+iUs
St. Francois County RSE
, Ko Screening Form
North Arrow
Sample Area Post Ex (XXX)
Post Pre Post Pre Cell 1 1711 CeU 13 544
Cell 2 12-42 Cell 14 34 2
Cell 3 12 2-4 CeU 15 352
Cell 4 244 CeU 16 5o1
Cell 5 2.3 68 CeU 17 li4o
Cell 6 744 Cell 18 2-OPff
Cell 7 2-015 CeU 19 Z.o4\
Cell 8 S?20 CeU 20 481 Cell 9 j5l7 CeU 21 2-0>o4 Cell 10 432, CeU 22 3O34 Cell 11 3Col > CeU 23 222 Cell 12 4 n CeU 24 7.n73
Pre Post Cell 25 aol
Cell 26 1111
Cell 27 3(o84
Cell 28 3"? 6.
Cell 29 l4(gS
Cell 30
Cell 31 303
Cell 32 ISTn
Landscape Qz.3
Lo.v\dSco it 2-'- 3s~{-
Pre Ex Samples Collected
Initials: "P*> tj fcF Date: lo-f-lo Time: o^op
Pre Ex Samples Analyzed
Initials: BtY\ Date: l o - z o - i o T i m e : i v o o
Sample Area Pre Ex XXX Samde Area Post Ex (XXX)
Pre Post Pre Post Pre Post TH-1 (0-6") <2035 TH-2(0-6") 2IS!? TH-3 (0-6") /40
TH-1 (6-12") 315 TH-2 (6-12") 318 TH-3 (6-12") 543
TH-1 (12-18") 40 TH-2 (12-18") 45 V.
TH-3(12-18 ")243
TH-1 (18-24") 2°l TH-2 (18-24") 38 TH-3(18-24") 4o4
TH-4 (0-6") /?? TH-5 (0-6") |50> TH-610-6") |g(o
TH-4 (6-12") .37? TH-5 (6-12") 22 TH-6 (6-12")
TH-4 (12-18") Iffl TH-5 (12-18") 22. TH-6(12-18") |<0I
TH-4 (18-24") 1?4 TH-5 (18-24") 23 TH-6( 18-24") |g?
TH-7 (0-6") 551 TH-8 (0-6") 22.5S TH-9 (0-6") 388
TH-7 (6-12") 71? ' TH-8 (6-12") 2IIC. TH-9 (6-12") 244
TH-7 (12-18") Jfc, TH-8 (12-18") \o$3 TH-9(12-18") 754
TH-7 (18-24") 01 TH-8 (18-24") 1134 TH-9( 18-24") /nS?
TH-10 (0-6") Mz.
TH-10 (6-12") 240
TH-10 (12-18") ^2 2
TH-10 (18-24") ^50
Property ED: School District
CcvyVroil 11A
Owner Information (if different from front) Superintendent Name & No. "De..s\ lAoj/^oerr^ 5TV Mg\- 21, lu Circle one: Cell<ffioh§
Principal Name & No. J.nois, Cc,\iz.w^ua ^71 - A 31 - 2-C, I L> Circle one: Cell^cpk
Other Contact Name & No. Circle one: Cell Work
School Address: City & Zip:
Mailing Address: Attn:
City, State: Zip:
Physical Description of House or Property (include age of school if known)
Loc.«.t<>c4 e-c^s+ dolle^c Ave. o-wvJ uOcsV of Siv-e-e-f-
GPS Coordinates: Latitude 3^ 3^13 Longitude ,
Does this property have a private drinking water well? Yes ^jty Water^Other:
Number of Students: ^,13
Approximate age range: \ 5 - \ %
Is the well shared by another property: __ Property ID:
Groundwater sampling location:
Depth of well: Treatment system in use? _ Type (filter, softener,etc.:)
Date Access to Screen Granted: !° *V-/o
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected, ect...):
Property ID: a o \ o
School Name: S^fccioJ Are.s &kc*.\e , Sckoo) St. Francois County RSE
Address: S l l % Siree.i- /°o. rL Hilk M6 Screening Form : ' 4>5i>o}
Sample Area Pre Ex XXX
Post Pre
J/4S
zzz Cell 3 Z°i(ol
Cell 4 Vo|
Cell i
Cell 2
CellS HHH
C e l l 6 323
Cell 7
Cell 8 H1 1
Cell 9 HQH
Cell 10 ~?H5
C e l l 1 1 Z l Z H
Cell 12 Z818
Sample Area Post Ex (XXX)
Pre Post
Cell 13 . ISJCfi.
Cell 14 38t>3
Cell 13 2577 : Cell 16 ZC,G>\
Cell 17 2C>£>%
Cell 18 1811 _
Cell 19 J2£2S
Cell 20 ZolX
Cell 21 37 UL
Cell 22 HozS . __
Cell 23 H z i f ?
Gravel Area 1 SCZL
Pre Post Gravel Area 2 3(oO
North Arrow
Pre Ex Samples Collected
Initials: ~Do tcTp" \y l>nto: io_-.Hr 10—. Time: Q%!S
Pre Ex Samples Analyzed
Initials: SM Date: lo /zof io Time: /)3o
Sample Area Pre Ex XXX Sample Area Post Ex (XXX)
Pre Post Pre Post ' Pre Post TH-1 (0-6") TH-2 (0-6") TH-3 (0-6")
TH-1 (6-12") TH-2 (6-12") TH-3 (6-12")
Iff-1 (12-18") TH-2 (12-18") TH-3(12-18")
TH-1 (18-24") TH-2 (18-24") TH-3( 18-24")
TH-4 (0-6") TH-5 (0-6") TH-6 (0-6")
TH-4 (6-12") TH-5 (6-12") TH-6 (6-12")
TH-4 (12-18") TH-5 (12-18") Tl 1-6(12-18")
TH-4 (18-24") TH-5 (18-24") TH-6( 18-24") '
TH-7 (0-6")
TH-7 (6-12")
TH-7 (12-18")
TH-7 (18-24")
!
<•
Property ID: Oo io School District
Owner Information (if different from front) Superintendent Name & No. -Bok> Aal-f - Circle one:<f>ThWork
Principal Name & No. ~Doz<x. 573- ^31 - ,3n~l(c Circle one: Cell($VQxk)
Other Contact Name & No. Bob 5e.lf LZio - ^3| - oog|
School Address: £\&\ Afreet
Mailing Address: Sc^rr\t a,s ccbove
Citv, State:
Circle one: Cell Workfd^x )
City & Zip: W.Us tN\o to3(oO\
Attn:
Physical Description of House or Property (include age of school if known)
loeo.\e.c\ AorVw of Kiddle -ScWool
GPS Coordinates: Latitude 37 g.^3^ Longitude _ 474^ 2.
Does this property have a private drinking water well? Yes d itv Water? Other:
Number of Students: 2 5 C S - z O ^ -
Approximate age range: ^
Is the well shared by another property: - Property ID: -
Groundwater sampling location:
Depth of well: Treatment system, in use? — Type {filter, softener,etc.:)
Date Access to Screen Granted:
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
ChoT visible oJewig d*Tcb InoeS
General Comments (visible areas where fill may exist or is suspected, ect...):
Soovc-e. C>( OSC-d
Property ID: Oo }Q
I | 1 '
;
; ; : > 1 i •
; ; ; ; \ \
j ; : : : I \ ! ! !
; ;
4-I !2>L-^ 4- • 1 Do . . . . . . . .
; ^ «**
\ | j ; * -(fy*" . . . . . . . .
\i$c > **
*>*
» » !
J \i$c
^ ; 1 \ ; | I : : \i$c
; 1
: L : : i i ! \ ' « \ I !
< :
i : : :
. . . 1 . . . H ; i' to . . ' 1 . . . . . 0
; ; ;
i . . . ; . : \ : f : I ; T
i 1 •n 5 \ \ : ( k : i 1 \ ! rr* ! ! !
— ... ; _ i L . H-* V : : :
I | i
* tnk.. 1 : :\ i i : : w\
i. It 1 Iff ; \ \ ; ; ; ;
06 : 3r.'
r ; i . y ^c-Ai-
. f h r.
£ J ^ ••' -—* i \ f\ J 1 !
'
i i : I V \ i : 1 '-r*. | ' ' 1
. . . - - - - - • - - - - % chooL.
- - - : . . I . i
' ; ' * V ' J . ! "* \ . . . . . . . . T — . . . . . . . . :
. . . - - - - - • - - - - % chooL.
i J ffH.4 : L J \ i i.
: THll - i i i I 4 \ ! ;
/• . IC& Yi *,! . ... i '.JII.j
. . . . .
. . . .
•
. . . . . . . .
;
t? I'-'
- - - . . . . . . . .
. . . .
•
. . . . . . . .
— .. l : - - - . . .
j — ; ; « j — ; . . . . .
. . . .
•
. . . . . . . .
• r " i ^ . . .
j — ; ; « j — ; . . . . .
. . . .
•
. . . . . . . .
i | ; 1 ; ; : \ ;
i i ! • j t aT"T'T" s : ' • • : V \
31 -- L — — r . j - i ' - i - Y . T " ^ » i
1 % * i : 1 ; ; ; \ . . . . { . . . . 4 :4e i \ \ to ; " : & &7)j3 ;"v \
-fill : : : j .
-i -: - - Ci- • 1 I : I : .1 ioJilfoj. J iVl idti f
: : Ji : : : : • : .1 ioJilfoj. J iVl idti f
: : Ji \ • ; : : : : : : \ i : i ; \
• j ; ; , ; ; ! ) • I J • [ j ]
Property ID: ; oo f[
6 f t School Name:
Address: 2-Q 60-"vf f Jo^-s^k Shr*.e.i-
Sample Area Pre Ex XXX
Pre Post ceii i y 57
Cell 2
Cell 3 Y(o ?
Cell 4 / 5"
Cell 5
Cell 6
Cell 7
Cell 8
Cell 9 "
Cell 10
Cell 11
Cell 12
&o r\ne, Tenre.
St Francois County RSE
Screening Form
Sample Area Post Ex (XXX)
Pre Post Cell 13
Cell 14
Cell 15 •
Cell 16
Cell 17 •
Cell 18
Cell 19
Cell 20
Cell 21
Cell 22 •
Cell 23
Cell 24
DW1
DW2
Garden
Play Area_
TH1 (0-6") t p i g TH2 -
TH1(6-12") "7g TH2 -
TH1(12-18")3g> TH2 -
TH1(18-24")24 TH2 -
TH3(0-6") •- TH4 ~
TH3(6-12") - TH4 -
TH3( 12-18") ~ TH4 ~
TH3(18-24") - TH4 -
North Arrow
Pre Ex Samples Collected
Initials: OP <1 CiD Date: lo - U - 10 Time: 113o
Pre Ex Samples Analyzed
Initials: , Date: / 0 / 2 1 //p T i m e : [ O O P
Property ID: QQ f \ School District
Owner Information (if different from front) Superintendent Name & No. FU.lker JoK/\ ScU^e. ide :^5'?/?-35>i ' - .2-H2-Circle one: Cell
Principal Name & No. Circle one: Cell Work
Other Contact Name & No. Circle one: Cell Work
School Address: 2o So.5Vre<ti- City & Zip: b3^;S
Mailing Address: _• Attn: . .
City. State: _ • Zip:
Physical Description of House or Property (include age of school if known)
p<x.r it- i i ! s^cie. of fr
GPS Coordinates: Latitude 37. °l24 3 Longitude ..553 7^2-
Does this property have a private drinking water well? Yes (€ By Water1 Other:
Number of Students: 2°i
Approximate age range: 4 - M -
Is the well shared by another property: Property ID: _
Groundwater sampling location: -
Depth of well: — Treatment system in use? — Type {filter, softener,etc.:) -
Date Access to Screen Granted: /o - 5 - to
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected, ect...):
0
Property ID: oo f {
i "'•
•
1 MM fL = JD h f r '
MM fL = JD
f /
Si teq
4
V ft > i - - --j i - - -
-j X*-A 5fc X*-A 5fc
"V
'2. 3
Pair Lit lot P<Li/jf iOrt j
'
; — —1- —
/
I1 I1
L
Property1 ID: OOI2-
School Name: A<~\y /VWf
Address: 3ol f4i't( crest 1'trfc.
St. Francois County1 RSE
Screening Form
Sample Area Pre Ex XXX
Pre Cell 1 .. 5Vo__
Cell 2..
Cell 3 _ 13 to
Cell 4 _ .3^5...
Cell 5 .334 Cell o IL
Cell 7 Z<\7-
Cell 8
Cell 9 II3
Cell 10 /'S9
Cell 11 .325
Drip Zone
Post
Sample Area Post Ex (XXX')
Pre Post Landscape
Play Area _ 7^/
Sample Area Pre E>: XXX Sample: Area Post Ex (XXX)
Pre TH-1 (0-6") 3Z(p__
TH-! (6-!2"i 5fe...
TH-1 (12-18") 22
TH-1.(18-24") 3'j
TH-4 (0-6") 3>\
TH-4 16-12") Iff
Post
Tl 1-4 (12-18") 25
TH-4 (.18-24") /*?
Pre Post TH-2 (0-6")
TH-2 (6-12") 00
TH-2 (12-18") 26
TH-2 (18-24") ZO
TH-5 (0-6") J8±__
TH-5 (6-12") JpQ,
TH-5 (12-18") ZO
TH-5 (1S-24"!)_2?O
Pie TH-'j (0-6" i loo
TH-3 (6-12") S8
TH-3Q2-18") 2.4
TH.-3(.18-24") 18
Post
Property ID: OC>l2. General Information / Comments
: A in Z le/cmi nCj Tree
Owner Information (if different from front) Telephone No. Circle all that apply: tenant owner home work ^CelT
Telephone No. Circle all that apply: tenant owner home work cell
Telephone No. Circle all that apply: tenant owner home work cell
Property Owner: Mailing Address:_
City, State: Zip:
Physical Description of House or Property (include age of home if known)
AsftlnJilf- dftyecocuj , bcLck ya_>"4
GPS Coordinates: Latitude 37.7,7^ Longitude -CjQ S3S2.i
Does this property have a private drinking water well? Yes ^SjZwareiPother:
Total Number of residents: Z 2.3
Number of Children less than 72 months of age: ^ ^
Is the well shared by another property: Property ID: ~
Groundwater sampling location:
Depth of well : Treatment system in use? Type {filter, softener,etc.:) —
Date Access to Screen Granted: jo -12-10
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist,or is suspected):
Property ID: Oo| 3
Owner Name: ^e/Aj ~Pt«<\e.n-/-
Address: # 2- So***
St. Francois County RSE
Screening Form
North Arrow
r Sample Area Pre Ex XXX
Pre Post Cell 1 7?-/
Cell 2 % (1 Cell 3 I Cell 4 V OZl,
Cell 5
Sample Area Post Ex (XXXI
Pre Post Cell 6
DW I
DW 2
Garden ? -2^
Play Area I 3 Y
Drip Zone
THI(0-6")7££ TH27g/;,
THI(6-I2") j/^5 TH2 /OP
TH1 (12-18") y/ TII2 Jg2 _
THIC18-24") %, TH2 03
Pre Ex Samples Collected
Initials: PO d Date: lO -ii, ~tO Time: //oo
Pre Ex Samples Analyzed
Initials: / Dale: ! 0 f Zi ! f r Q Time! (100
|
i; • • • - • • •
1
r< II 1
' 1: i|: ;
4
i " T : i
i I;
J WW *•—ir-' rr J J
) f 1
) f 1
, i Pi -A /
~\<c*sc 1 &
} i i
SoiAf \e T uct_ fi n
& % : \ I
T •r [
14 tA -SF ?
i c 1 4
1
_.j
Cg|V 2. !
* ;i
>
iJ
\ i
] i Pccy ki<M Ui -
i \ 1
is I !
YV. V
1 fc;
fl ; V
1 fc;
fl
: 1
! V
V d'
3
1"
1
p i * . i ft t
i J JL
• X 1 ft - Jooft
Property ID: QQ {3 General Information / Comments
• Terr*. fit*d _ff Owner Information (if different from front)
Telephone No. Dc^e-nt Circle all that apply: tenant owner home work cell
Telephone No. Circle all that apply: tenant owner home work cell
Telephone No. Circle all that apply: tenant owner home work cell
Property Owner: . Mailing Address:
City, State: Zip: •
Physical Description of House or Property (include age of home if known)
locked U)ifL)e\ HoO Feci- oF file-, bncU buttcfm^
GPS Coordinates: Latitude J7 ^z5,( Longitude - %
Does this property have a.private drinking water well? Yes C ifitVVatei- Other:
Total Number of residents: < • 1 r-J° reSt Jen G
Number of Children less than 72 months of age: Y0 ( ? - $)
Is the well shared by another property: — Property ID: —
Groundwater sampling location:
Depth of well: Treatment system in use? — Type {filter, softener,etc.:) —
Date Access to Screen Granted: /o -11- m
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property :
General Comments (visible areas where fill may exist or is suspected):
Property ED: ooM
Owner Name: C^ss!c/a-.cj Sa St. Francois County RSE
Address: Tivcmmes St Park l-fil Is, Mo Screening Form
North Arrow
Sample Area Pre Ex XXX
Pre Post C e ll 1 /DIP"
Cell 2
Cell3 l O l j Cell 4 2 /? 7
Sample Area Post Ex (XXX)
Pre Post Cell 6
DW1
DW 2
Garden
Cell 5 Play Area.2_2_7
Drip Zone
TH 1(0-6")
TH1(6-12")_
TH1(12-18")
THl(18-24")
Pre Ex Samples Collected
Initials: ~Oo £ &S Date: /o -!zl- /o Time:
TH2
TH2
TH2
Pre Ex Samples Analyzed
Initials:
TH2
i f- tell I
—*~l i—1 f-— —X? -••• —. 4
- !v. ; J i i
!
(
i u
)Cov
i :
!
—
i
|
5s -_ l i r
)
!
.
V ' J
xs
1 if )Cov Cr£k- !
—
i
|
5s -_ l i r
)
!
.
li 5
)Cov Cr£k-^ ;
I'
i
i
'!i ;[ i i j
K j
X
.1
e 12
iEFIeJ
1
i i
i
i t i
< p i 1
.1
e 12
»V- i Vc QH-t
jkzS 'j&JTA
t
]
•l
Tic A*
i lr> i I
1 I
jkzS 'j&JTA
>i
:\
•1 ') 1
1
if\ } 1
; : r i
•]
s. i ; ; ; 1 1
.i
.1
f 4 UAT{ = lc
! . I 1 1
i ;l
si
\
i i
j p. -vUAy,
;
_Uv
— 1 • i; j;
) t
s i " i Itll: L
' ; _!
i
dt II 4
\\ V 1
i
i
1 V ,i\
:
: •
• v f '
; • v f '
T—_ ."j.-! "II i - •
-
V \ • i i
2- Cell 3 .•sr.'r? 1 -
V \ • i i """ "
; ; •
Property ID: QQ General Information / Comments
Owner Information (if different from front) Telephone No. ?• 431 - ZffZ. Circle all that apply: tenant home ^eSC cell
Telephone No. Circle all that apply: tenant owner home work cell
Telephone No. : Circle all that apply: tenant owner home work cell
Property Owner: Mailing Address:
City, State: Zip:
Physical Description of House or Property (include age of home if known)
n3 "faun S f~C.e.l b<*.t'icii'v\Q C-a / fti cJ U- brouSn Tr i nn
GPS Coordinates: Latitude 3 7 ^5^ Longitude _ ^ 5 2
Does this property have a private drinking water well? Yes Other:
Total Number of residents: -/zT)
Number of Children less than 72 months of age: Se.ves-«,l
Is the well shared by another property: _ Property ID: —
Groundwater sampling location:
Depth of well: Treatment system in use? Type (filter, softener,etc.:) —
Date Access to Screen Granted: 10-12 - 10
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
\f 1 'zihlc c.^f~ nta.r road Uqjy
General Comments (visible areas where fill may exist or is suspected):
jZo- i 's d />1 C.t/( *f
Property ID: oO|6
Owner Name: Cafhi
Address: j?Qi
Sample Area Pre Ex XXX
Pre Post ceii i y / £ Cell 2 3
Ce 113^7^
Cell 4
Cell 5
"Pes
. St. Francois County RSE
p.'slo-.ai Screening Form
Sample Area Post Ex fXXX)
Pre Post Cell 6
DW 1 // %
DW 2
Garden
Play Area 1^/0
Drip Zone
TH1 (0-6") fflPj TH2_2£lZ-
TH I(6-12")Ttfl TH2 /^L/
TH 1 (12 -18")//A TH2 .S~6>
TH 1(18-24") TH2^£l
North Arrow
Pre Ex Samples Collected
Initials: pe? Dale: ) Q ' j Z - l O Time: (5Q&
Pre Ex Samples Analyzed
Initials: Date: (.t [3-< j (h Time: i_LU_0_
•r.lGfkJit t
Ceili 3 TV. ve ujt\ ..I *... V-
PI Avti e^.
£ to> A«CtjC>»\ ~irW *
(0 CeJk
-'sicUs. jejlcl 'Ccp
mvASjCC 1 >i/«r J
Ce/
Property ID: QQ J 15 General Information / Comments
fc- 14 i •Covw\gcd-ior'>
Owner Information (if different from front) Telephone No. CtJ-k', Ai h^U o n Circle all that apply: tenant owner home work cell
Telephone No. L > & < x lt<*i e. Circle all that apply
Telephone No. Circle all that apply
Property Owner: Mailing Address:
City; State: Zip:
tenant owner home work cell
tenant owner home work cell
Physical Description of House or Property (include age of home if known)
/clloui s.aincj Wtu.se usu-.vt sUuvVt-t.^ c^Jl bw r0of
GPS Coordinates: Latitude ^ % 7 1 z q Longitude - 70.5^59
Does this property have a private drinking water well? Yes CrtY-Watcr Other:
Total Number of residents: f j a /.dS
Number of Children less than 72 months of age: ( c , L >o z e.kJS - olcT) 1
Is the well shared by another property: Property ID: —
Groundwater sampling location: _
Depth of well: _ Treatment system in use? - Type (filler, softener, etc::) -
Date Access to Screen Granted: ! o / z - / o
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected):
Property ID: Go I G
Owner Name: AsInlt.j FrrrgH St. Francois County RSE
Address: VOo M . C. Slo.dc R-ooJI BOKAC Screening Form HP kZhZR
North Aitow
Sample Area Pre Ex XXX
Pre Post Cell ) 1 [
Cell 2 /'£_[_ as$T-
Ccll 3
Cell 4 (7
Cell 3
2J
Sample Area Post ExiXXXt
Pre Post Cell 6
DW 1
DW 2
Pre Ex Samples Collected
Initials: T>e>if. &i3
Garden
Play Area 2
Drip Zone _
TH1(0-6")S>^L TH2_
TH 1(6-12") JO TH2_
TH 1(12-18")//^" TH2_
TH 1 (18-24") /^$TH2
Date: lot (3 I/O Tinie: !o3S
Pre Ex Samples Analyzed
Initials:
Date: lo/'S-i/fO Time: / 5 Ot?
u JAui/Sf..?. i c Qtk*
'TS^«a. *• -^S=r-" \c;'i ZWcU eJTtl
u JAui/Sf..?. i c Qtk* i I
ZWcU eJTtl
u JAui/Sf..?. i c Qtk* V t Pic '
^irecA.; > V
Wc op^-4-
\y -
\ ;
Wc op^-4-
\y -
\
o op^-4-
\y -
Pj!
a V
.Its feg's __£g
£
~lf>vc
Tl'fM Ce'^-i-cy
JK6. Ltd. 5 1
•\i r
\
i \ p [ n jJZ.B i \ p [
' |
1 * j.
' | IS ^ /
xxxxs.-, .
J 1 ^X'.-Cil 3 j di 4 J
j l\
j j ;
:
JF? Y
:
i ; C
: Ce/l
*.\v£.r
z-
Y ; pei irk. ip q L t>I i ; C
: Ce/l
*.\v£.r
z-
Y
i jr"
j
r> S3, ;
; \ I ; u-if ; i \|
.... . . .
I ; u-if
fZ :r i rxt3
.ii'a&iaStW-
Wcv I i .... . . .
i J
; Ceil i V
1 ; ; •
. 1 s M.c . B)e\cit J i i •> • X • , . : ••
Property ID: 00\(& General Information / Comments
"To<Ja,lj ' 5 bicJ/j.-- "Tofiorroitj 's ~70 rt*jv\S t. a f-ior\a! dttjj-tr
Owner Information (if different from front) Telephone No. AsMeu Fcrrel l 5~73 - Tfiff ~5Loc Circle all that apply: tenant (*crtvn&r home (<So3ty cell €~3r Telephone No. Circle all that apply: tenant owner home work cell
Telephone No. Circle all that apply: tenant owner home work cell
Property Owner: Mailing Address: •
City, State: Zip:
Physical Description of House or .Property (include age of home if known)
[o I Icj t VeMowi s idiVi^ , u3 kTe 4riwi . 5 ow b*».>
GPS Coordinates: Latitude ^ i f S c Longitude - ^ o . S Z - c ^ t o
Does this property have a private drinking water well? Yes (G bty. \Yatet) Other:
Total Number of residents: /, , (k to L -clcS — i-l<Lo l d )
Number of Children less than 72 months of age:
Is the well shared by another property: Property ID: -
Groundwater sampling location: _
Depth of well: - Treatment system in use? Type (filter, softener,etc.:) —
Date Access to Screen Granted: t o - / S - l o
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected):
Property ID: c»o f?
Owner Name: Vickie. "Tie St. Francois County RSE
Address: <5o3 Y^lc Sh-e^i - Bonn. Terse Mo Screening Form ' ' k lk l -S
North Arrow
Sample Area Pre Ex XXX
Pre ___ Post
Cell l.J5L?A.
Cell 2 /£ 3
Cell 3 I ? £
Sample Area Post Ex (XXX)
Pre Post Cell 6
Cell 4 /
Cell 5
DW 1 7 (, ?
DW 2
Garden
Play Area / 0.3
Drip Zone 3 ( _
TH1 (0-6") !&3 TH2_
TH1 (6-12") JJci ™2_
TH1(l2-18")/t9V TH2_
TH 1 (18-24") A0TH2
Pre Ex Samples Collected
Initials: T>o d &B. Dale: 10-13-/0 lime: Ufa
Pre Ex Samples Analyzed
Initials:
Date: I 0 / 1 (( o Time: f 1 .3 O
1 <i cjuar p. - / €0 P
\ |
cjuar
: 1 1
1 i 1
J ^ -
i
: t
ed
S : t
ed
i :
C M 3
: I
1 |
fi A rco. 1
• :
. i CfO-t. :
/v i •
r
i ecAjd M<-> li
»r.:. i: * !• 1
1 2-v: 1
C^MI d L 1 : :
lit : i ?
T> At
(. 1 r\&
fof
U\y •"3" e
• i / ; /)
/i L
uJ
fii i I
?
T> At
fof
U\y •"3" e
• i / ; /)
/i L
uJ
Tti-lrt :
?
T> At
fof
U\y •"3" e
i P
/i L
uJ
j
!
i
l e i l I
: j
i
i : t: ; a
1 / .'it / C«i 4
: 4
i L . _
Aij0 tAix.ii- V J<
j
• ;
Property ED: Oo If General Information / Comments
<xnd p/4 At/ /?
Owner Information (if different from front) Telephone No. V'c(c-/'g PejeWq 5 7 1 - Q 3 7 7 Circle aJI that apply: tenant home ®53D cell
Telephone No. _ Circle all that apply: tenant owner home work cell
Telephone No. ; Circle all that apply: tenant owner home work cell
Property Owner: Mailing Address:
City, State: Zip: .
Physical Description of House or Property (include age of home if known)
GPS Coordinates: Latitude 37^2 Longitude _ 9o. 53o9,/
Does this property have a private drinking water well? Yes Ggy3Vat<)r Other:
Total Number of residents: z3 C n fb IZ u^i old)
Number of Children less than 72 months of age:
Is the well shared by another property: Property ID: —
Groundwater sampling location:
Depth of well: Treatment system in use? — Type {filler, softener, etc.:) —
Date Access to Screen Granted: to - /? -to
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected):
Property ID: ool?
Owner Name: Mel issa . T^ck-sot1 St. Francois County RSE
Address: S .o4 ~beslr>ae-.Mn Screening Form : J ' (a2>loO i
North Arrow
^
Sample Area Pre Ex XXX
Pre Post Cell 1 TV f
Celt 2 ^27
Cell 3 (5 ?
Cell 4
Cell 5
Sample Area Post Ex (XXX)
Pre Post Cell 6
DW 1 lQ<f
DW 2
Garden
Play Area Z2 ( C
Drip Zone _
TH 1(0-6") f-jhto TH2_
THl(6-12")ii^ TH2_
THI(12-18")^1 TH2_
TH1 (18-24") 77 TH2_
Pre Ex Samples Collected
Initials: t>o 4 &B
D a t e : / ° ~ 1 3 - / C Time: /3to
Pre Ex Samples Analyzed
Initials: Date: / o f < ( fd Time: ( 5" 13- <?
1 •i.r.j 00 ft* -•i.r.j
% %
i
CL\Y£
'! < ii !
* ;
•f > £<:/{ £
- - - - - - - - - - - - - - - — r -
A V
9 - - - - - - - - - - - - - - - — r -
A V r< i 7 if / J
: a
•\ Ul< 2
7 if / J
: a
•\
Cdi i i i
""
'*
jf if * fH 1
j: i
'*
'
--,y y 'i
. j*
J
i / y 'i
. j*
J ' j
^0 fi •- +K < _e-Kf eod-il
Property ID; OOl% General Information / Comments
Graridsha's House, Cl*;lA C«re Certify
Telephone No.
Telephone No.
Property Owner:.
City, State:
tenant home (^ork) cell
tenant owner home work cell
tenant owner home work cell
Mailing Address:_
Zip:
Physical Description of House or Property (include age of home if known)
UJh.k cs door. Circle gr^tl d~ve
GPS Coordinates: Latitude 37. *74 2.1 Longitude -^0.5,3304,
Does this property have a private drinking water well? Yes ate?) Other:
Total Number of residents: l4 (3- - /&)
Number of Children less than 72 months of age:
Is.the well shared by another property: Property ID:
Groundwater sampling location:
Depth of well: Treatment system in use? — Type (filter, softener,etc.:) __
Date Access to Screen Granted: to - /% -/p
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected):
Property ID: O&l^f General Information / Comments
Jject^lj's "Dc^tjCe~rj
Owner Information (if different from front) Telephone No. ForShet S 73 - 5C,2- 783*]Circle all that apply: tenant owner home work cell
Telephone No. ; Circle all that apply: tenant owner home work cell
Telephone No. Circle all that apply: tenant owner home work cell
Property Owner: Mailing Address:
City, State: Zip:
Physical Description of House or Property (include age of home if known) -
3^ fjdloui StcfiKj , uikilt br'mn { rtA 1-irs
GPS Coordinates: Latitude 37.^307^ Longitude _ ^0.L,l5gJ
Does this property have a private drinking water well? Yes GtfyS^ater Other:_
CUAIcS<-tv\ Total Number of residente: /0luJ k0,n C,KJ up .
Number of Children less than 72 months of age: se.\jexz^\
Is the well shared by another property: _ Property ID:
Groundwater sampling location:
Depth of well: Treatment system in use? Type {filter, softener,etc.:) —
Date Access to Screen Granted: !o - /5 - /o
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected):
Property ID: oo2o
Owner Name: BilU S;sfz St. Francois County RSE
Address: 7o3 ET^s - i - SWe.eA- P^k- WUs , Screening Form Mo 63Cod t
North Arrow
V Sample Area Pre Ex XXX
Pre Post Cell 1
Cell 2
Cell 3
Cell 4
Cell 5
Sample Area Post Ex (XXX)
Pre Post Cell 6
DW1
, PW2 LajnaScadc- i IJj 2 *7 'VJaruuu yn "p.o.
Play Area 55$
Drip Zone
TH 1(0-6")
TH1(6-12")_
TH1(12-18")
TH1 (18-24") TH2
TH2_
TH2
TH2
Pre Ex Samples Collected
Initials: ~P o ('r%
Date: to - / to Time: nfttt
Pre Ex Samples Analyzed
Initials: BM Date: f Time:
ofz- l j lo lb 15 .
1 .... s i i I ;
(
l
1 j
\ = 55 T'V"
l~* f • ) w
OL A* S jO . )
•:
l
| | u i
i
t
i i
} i I f 1
J i
|
i
A j • • , i _ ! A j •
i An AbiJcv^J l°io
i Ce^vVty
i •
;
A
Lao-
ed JisCc
|
! ! "Po.tr ljtJ»w^ Cof
> \Ascej * r
I l' r 1
!
;
•
r
Property ID: 00 General Information / Comments
All A bpCO^gl Pi Q-M Ig^rn C.&n-fg-v
Owner Information (if different from front) Telephone No. 573 - 4.31 - I\ C Circle all that apply: tenant cfiwribr home <Woflp cell
Telephone No. Circle all that apply: tenant owner home work cell
Telephone No. Circle all that apply: tenant owner home work cell
Property Owner: Mailing Address:
City, State: ; Zip:
Physical Description of House or Property (include age of home if known)
UJkiU me-Ul ujU-K greCKi <TooP <^d +r|^, Adjo.ce.M- -|o Son\c
GPS Coordinates: Latitude 37. * \oo Longitude 3z5
Does this property have a private drinking water well? Yes City Watefr Other:
CiMleire^y Total Number of residents:
73. <9. 54 ( 2. - / 3 )
Number of Children less than 72 months of age: UNlfC
Is the well shared by another property: Property ED:
Groundwater sampling location:
Depth of well: Treatment system in use? Type (filter, softener,etc.:) —
Date Access to Screen Granted: /£> - 1*1- !Q
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected):
Property ID: OQ
Owner Name:
Address:
M tchp./le.
UH Jfi.pCe.rSo/\ Park. ftilksMn
St. Francois County RSE
Screening Form
North Arrow
' V
Sample Area Pre Ex XXX
Pre Post Cell 1 22Q 3
Cell 2 5
Cell 3 4^3 '
Cell 4
Cell 5
Sample Area Post Ex (XXX)
Pre Post Cell 6
DW1 231
DW 2
Garden
" P I / \ v e ^ 2 : Dun Zone @0
THl(0-6")_
TH1(6-12").
TH2
TH2
Pre Ex Samples Collected
Initials: ~t>o £ 6rB Date: /o - 1*1- fc Time: nfPLP
Play Area I'. 1677
TH1(12-18") TH2_
TH 1(18-24") TH2_
Pre Ex Samples Analyzed
Initials: SlA Dale: lo/2-\|\o Time: 1U2.Q
i VP. Jo. VP. Jo.
-
_ _
ftr: i _ _
ftr: i _ _
k-\ j ri i i
^ J
i l i f ! t ! t. i t ! K
) : L
. .— ]L ys
?
! S L.J 1 V : \ i
-! Pla 2.
_ r^7~T.
. .— ]L ys
?
! S L.J 1 V : \ i
-! Pla 2.
1)^ C^.ve. i f . .— ]L
ys
?
! S L.J 1 V : \ i
-! Pla 2.
1)^ C^.ve. i Jr
T i [. i t :
i t j Y-, \ r : r
/cfiU3 cjfe. ]
! | i V i
2 ; :
/
! | i V i ' '
2 ; :
/
f - i |)-i
C6 11 Z. . t i t-i | flcv. | Are -c 1 3 Mj 'twjf
; 1 ! i
t
ji i 1 |
n L&H i i
L L l.i
\
L
i ?OA I
Property ID: QO 2-1 General Information / Comments
PAsiJjLr- CGky Cstre ny (if d Owner Information (if different from front)
, Telephone No./VI/rA^//^ - $545 Circle all that apply: tenant cQWrTen home^^f^ cell
Telephone No.
Telephone No.
-Property Owner:
City, State:
Circle all that apply: tenant owner home work cell
Circle all that apply: tenant owner home work cell
Mailing Address:
Zip: _
Physical Description'of House or Property (include age of home if known)
CM \V\t cd^l/ o-f "7*1% 5fr-c.«.t- Jc(J-trs<SA Sfreeb. Fenced 'oo
pWlj O-VZJK
GPS Coordinates: LaflWde 37i?5o|5 Longitude -<fo. ^(^SCf
Does this property have a private drinking water well? Yes CCttyAVater) Other:
Ck-'l <3rt/\; ~ Total Number of residents: ^ O (2 - p )
Number of Children less than 72 months of age: (J /vj |<C.
Is the well shared by another property: Property ID:
Groundwater sampling location:
Depth of well: Treatment system in use? Type (filter, softener,etc.:)
Date Access to Screen Granted: !o~ f t) - to
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected):
Property ID: 00i_2-
Owner Name: /.t^ Uuj-ckirys St. Francois County RSE
Address: 3.o4 7g/ifA thlls, Mo Screening Form Q 36>at
North Arrow
Sample Area Pre Ex XXX
Pre Post
Cell 1 ILA5
Cell 2 "fop 4
Cell 3 13k??
Cell 4 RS3
Cell 5
Sample Area Post Ex (XXX)
Pre Post Cell 6
DW1 T?"
DW 2
UAIUCl! JA
Drip Zone
THl(0-6")
TH1(6-12")
Play Areq^j03l
TH2
TH2_
TH1(12-18") TH2
TH 1(18-24") TH2
Pre Ex Samples Collected
Initials: T> o d CTR Date: to - H - to Time: ie to
Pre Ex Samples Analyzed
lnitials:_ gHA Date: io-Zi - lo T i m e :
Property ID: 2^ General Information / Comments
Owner Information (if different from front) Telephone No. Le*K £~?3- 43\ - £ t*58 Circle ail that apply: tenant home ctfofy cell
Telephone No. Circle all that apply: tenant owner home work cell
Telephone No. Circle all that apply: tenant owner home work cell
Property Owner: Mailing Address: -
City, State: Zip:
Physical Description of House or Property (include age of home if known)
7^ siding, yee* roof. Urji 0„
GPS Coordinates: Latitude 37. Longitude _
Does this property have a private drinking water well? Yes j^jtv\Vafer Other:
Total Number of residents: ^ ^
Number of Children less than 72 months of age: $0
Is the well shared by another property: Property ED:
Groundwater sampling location:
Depth of well: Treatment system in use? Type (filter, softener,etc.:)
Date Access to Screen Granted: /b - ftf - /b
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected):
Property ID: OQ 2.3
Owner Name: i'g. |2o|g.|'s i St. Francois County RSE
Address: 10 S5/xf^i Hills Screening Form
North Arrow
•Sample Area Pre Ex XXX
Pre Post
Sample Area Post Ex (XXX)
Pre Post Cell 1 Cell 6 Drip Zone
Cell'2 DW1 TH 1(0-6") TH2
Cell 3 DW 2 TH1(6-12") TH2
Cell 4 Garden TH1(12-18") TH2
Cell 5 Play Area ~lL5 THH18-24") TH2
Pre Ex Samples Collected
Initials: "Do 4 ts& D a t e : 1 0 - l A - m
Time: II to
Pre Ex Samples Analyzed
Initials: 'fil'A-Date: l o / a i / l o Time:__](efl5__
Property ID: <3<92.3> General Information / Comments
Owner Information (if different from front) _ Telephone No. .47 - 43 I -S(oSo Circle all that apply: tenant^wngp home (3yor}s) cell
Telephone No. Circle all that apply: tenant owner home work cell
Telephone No. Circle all that apply: tenant owner home work cell
Property Owner: Mailing Address:
City, State: Zip:
Physical Description of House or Property (include age of home if known)
S fide, howse. wifh while. hn'm <wnof fenced in Oi.re.ek.
GPS Coordinates: Latitude 37.S4.a4? Longitude -%.5ool?
Does this property have a private drinking water well? Yes (^k^^atep) Other:
Cu'.ld niy\ Total Number of residents: 3 . ~~f )
Number of Children less than 72 months of age: (J |vj )C
Is the well shared by another property: Property ID: —
Groundwater sampling location:
Depth of well: Treatment system in use? Type {filter, softener,etc.:) -
Date Access to Screen Granted: /O" M - to
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected):
Hecjfh "Depc^-t-WTe^}- Soowpled Cample- oC ye.cvy.5 o-Op o.«d -Ltd
proper ouooef fo I • v\e •plo-t/j a.re ex ioi+U \a.i~dse ape fo. to r! c
Property ID: a&Aij
Owner Name: Pontic. St. Francois County RSE
Address: J\Q5 f.^1^ SU,A & I Is. ^Screening Form
Sample Area Pre Ex XXX
Pre Cell 1 4^~l(g
Post
Sample Area Post Ex (XXX)
Pre Post Cell 6
Cell 2 10 <M
C e l l 3 ' / ^
Cell 4
Cell 5
DW1 1331
DW 2
Garden 300
Play Area 1ZI5
Drip Zone I7l5 _
TH 1(0-6") TH2
TH1(6-12") TH2
TH1(12-18")_ TH2_
TH1 (18-24") TH2_
North Arrow
" ^
Pre Ex Samples Collected
Initials: *Do 4- drS Date:_ Time:
o-id - lo M3?
Pre Ex Samples Analyzed
Initials: f^rA Dale: I0-2.I-10 Time: If 15
Property ID: QOX1^ General Information / Comments
Owner Information (if different from front) Telephone No. ^73- £ 18 - Circle all that apply: tenant—owngp <SSEE? work cell
Telephone No.
Telephone No.
Property Owner:
City, State:
Circle all that apply: tenant owner home work cell
Circle all that apply: tenant owner home work cell
Mailing Address:
Zip:
Physical Description of House or Property (include age of home if known)
Bov-cb-- (jixvcl fo.Ct-5 Ce.kvVmo-1 ScJr~Oo\
GPS Coordinates: Latitude 37. ^5^ %5o Longitude - 5 Z 5 Jo~T
Does this property have a private drinking water well? Ye^TcityWate? Other:
Total Number of residents: (_ tne-LoboriO -
Number of Children less than 72 months of age: <,t.M e.\-a.\
Is the well shared by another property: Property ID:
Groundwater sampling location:
Depth of well: Treatment system in use? Type {filter, softener,etc.:)
Date Access to Screen Granted: j o - l A - 1 0
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected):
Property ID: oozkS
Owner Name: Sc-Kt l/J iVict-1 St. Francois County RSE
Address: Ho 3 SOIA-IK ScKool De-slcge, Screening Form /Vto (a J&(oO 1 ••
North Arrow
Sample Area Pre Ex XXX
Pre Post Cell 1 IZ o I
Cell 2
Cell 3
Cell 4
Cell 5
Sample Area Post Ex (XXXI
Pre Post Cell 6
DW1 12.31-1
DW2_J3Z3_ _
garden 22"? 2,
Play Area t* 2". R
Drip Zone 3.7 oo _
TH 1(0-6") TH2_
TH1(6-12") TH2
Pre Ex Samples Collected
Initials:~Pd ^ 6)3 Date: /o - /*j -/o
TH1(12-18") TH2
TH1 (18-24") TH2
Time: \lo3.0
Pre Ex Samples Analyzed
Initials: ftflA Date: lo/zz/io Time: OfflS
1
i
>
i 'ScJt.li
w. 2. j
kp £UA I svejL1
! t' . . . .
Lit
1
1
£ r p J . .
I il
P
J ! ; i
j-
ii 1;
1
s
)
0 ;
i
1 • '
ii
i :j
I i \
1
1
1
6 *1
i
tl
|l
LrOVS.
tl
|l
M il LrOVS. re_d..L^>sc!
i! O 1;
il 1 r
\
1
!
1
J
j! i
— 4-
1 )
(
1
11 #
'i /
.1 / ii 1,
DViV Stooaj % 2-} I
! j • \
\
i
i
4e.-w-^ ILee t===SJ- w?r»Ar.— fglTTTt---—— "."a / 6
4e.-w-
r —~ 7-/
T>rl tJ i ; —
: j
Property ID: (QQT-'y General Information / Comments
Sr -ri TEURA P/g*y "f- I J2#C\A. F &CKCT Owner Information (if different from front)
- t\3\~ .^2.10 • Circle all that apply: tenant <5wBgr~^home cffioriT^ cell Telephone No._
Telephone No._
Telephone No._
Property Owner:
City, State:
Circle all that apply: tenant owner home work cell
Circle all that apply: tenant owner home work cell
Mailing Address:
Zip:
Physical Description of House or Property (include age of home if known)
hoi^se_, HM-C +1n<r\
GPS Coordinates: Latitude -37. #£7°'? Longitude - q0. 5ZZ^C,
Does this property have a private drinking water well? Yeg^Otv Wate -itv Water Other:
Total Number of residents: *^5^K\g.uolooir^ —zT)
Number of Children less than 72 months of age:
Is the well shared by another property: Property ID: -—
Groundwater sampling location:
Depth of well: Treatment system in use? — Type {filter, softener,etc.:) _
Date Access to Screen Granted: /o - /4/- Jn
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected):
Property ID: OO^Cs
Owner Name': T)ZA i SC. A\ cy \ t r St. Francois County RSE
Address: H o P o i ^ - f t / i c u o j 3 o r m e " T e y-rg.tMoScreening Form
North Arrow
Sample Area Pre Ex XXX
Pre Post
2fcl '
Sample Area Post Ex (XXX)
Post Cell 1
Cell 2
Cell 3 |g&
8.82.
Cell 4 111
Cell 5 35g
Pre Cell 6 2g2
DW 1
DW 2
Garden 11°|
Play Area UC
Drip Zone
TH1 (0-6") ? TH2 "75" TH2 g.S
TH 1(12-18") M TI12 il. TH1 (18-24") [°! TH2
Pre F,x Samples Collected
Initials: ~Po 4 &B Date: !o - IS- /c Time:_ otM5
Pre Ex Samples Ajialyzed
Initials: BW Date: 10-22.-10 Time: n^oo
l.Sfi 'wtrXZ. -Jacit1
\: J
I -
i £Jvi c |2erj !o„ori 4
: 1 s ; \ I ;
• " ...
1 J • " ...
I; ' ; i
W Ce il 5
1 : f leotj i • i
I-\t
i i j il ;)-vtesst- — ' J
i! ;l
I ;
1: t. 1 Co vVF\iv
ui 1; |
"^O&cC Nl
Ct»4ky Cttl
1 : ei(;? i UK 4
r
i ; !\
i Crt
i
TH 2-
~j ... . ....
i
"f TH 2-
~j ... . ....
r
& Asc lukjl- Pwile) !• 1
! 7.
>
t
3 i.
%r :
i I :/
Lis
@ i
j i i @ i'z:!: . r-
s • i V ~ 7-
: Cz /
1 2. ; To, "ti t/i£ to 1 'rivfc
Property ID: OO General Information / Comments
Owner Information (if different from front) tenant t-gCvnet home ^worfo cell Telephone No.Tt>i/ig Ma ^/ry fy?- 3 Circle all that apply
Telephone No. ' Circle all that apply
Telephone No. Circle all that apply
Property Owner: Mailing Address:
City, State: Zip:
tenant owner home work cell
tenant owner home work cell
Physical Description of House or Property (include age of home if known)
£ id ii "oovo -SUc*. tierS
GPS Coordinates: Latitude j7^1#^/ Longitude - < ^ . 5 - 3 ^ 7
Does this property have a private drinking water well? Yes ^ ifipWate'r Other:
C-U'i lolrS-fi; Total Number of fa _ ^ ^
Number of Children less than 72 months of age:
Is the well shared by another property: — Property ID: —
Groundwater sampling location: -
Depth of well: __ Treatment system in use? ~ Type (jlller, softener, etc.:) —
Date Access to Screen Granted: /p - /5~ - /O
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected):
Property ID: 00«2~7 General Information / Comments
Owner Information (if different from front) _ Telephone No. 5 f 3 - 5 to 2. - 3% j Circle all that apply: tenant <Qvmt?r home C^vorie) cell
Telephone No. Circle all that apply: tenant owner home work cell
Telephone No. Circle all that apply: tenant owner home work cell
Property Owner: Mailing Address: f.n. fenv MoT
City, State: , N\o Zip: G>3(o^4
Physical Description of House or Property (include age of home if known)
VtUoio S ' c j i , uAolc . 4 r i iW
Sicj l\ v w fv<»vxV uo-rji
GPS Coordinates: Latitude 31 . %(o(pC> 3 Longitude ~<^0
Does this property have a private drinking water well? Yes 'r Other:
C~l\ i (d rer] \ Total Number of -residents: I n / ,
. -P.O. oLO jl ~ !ZL (AC.WS old )
Number of Children less than 72 months of age:
Is the well shared by another property: Property ID:
Groundwater sampling location:
Depth of well: Treatment system in use? Type (filter, softener,etc.:) ~
Date Access to Screen Granted: |Q - is - io
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected):
Property ID: 003i
Owner Name: fA^rj Frie-Jr ich St. Francois County RSE
Address: //Q9 AWM Dcs/oae. "Drive. ZWg^/wScreening Form
North Arrow
T
Sample Area Pre Ex XXX
Pre Post Cell 1 ft! 7
Cell 2 1^5 Cell3 IS I
Cell 4
Cell 5
Sample Area Post Ex (XXXI
Pre Post Cell 6
DW I
DW 2
Garden
Play Area 1^1
Drip Zone
Till(0-6") UtH- TH2_
TH 1(6-12") 1L TH2_
.TH 1(12-18") W TH2
TH 1(18-24") TH2_
Pre Ex Samples Collected
Initials: Po CC Date: !Q - zo - to Time: ftfzo
' Pre Ex Samples Analyzed
Initials: ~p o Date: Jo -Ti me: /SnO
\
jc&-
, Cd\ I i
i
- ..
? _;PU UU.. '
? _;PU
•
s i: : i
(PA ) ;
|. : r- u. lelr &
L
a s •;
j >
& '
•II !
&
L LC "" C a U>'£f
?, '.oC.s $ —
?, '.oC.s $ Td J
f i 'M- i <
( f I'Bv . . } I
A j-] '
v Ufa f "
i %
L- -w i
i
J • r ; (, t 7 i . 1 " - -J (i
• •: :J::i J - -J
Property ID: OO 3 j General Information / Comments
Ckfldser\ 's LLC
Owner Information (if different from front) '
Telephone No. Frie.Js,'ch ^3) - 12.0*1 Circle all that apply: tenant cgwnei^home CffiorK) cell
Telephone No. Circle all that apply: tenant owner home work cell
Telephone No. Circle all that apply: tenant owner home work cell
Property Owner: . Mailing Address: !
City, State: • Zip: .
Physical Description of House or Property (include age of home if known)
uoUTe hlc^ck.
GPS Coordinates: Latitude #7^72. Longitude - f o . 5 2 .14 /
Does this property have a private drinking water well? Yes CffyAVateh Other:
Total Number of residents: 3^ ^ 2 -i£)
Number of Children less than 72 months of age:
Is the well shared by another property: Property ID:
Groundwater sampling location:
Depth of well: — Treatment system in use? Type (filter, softener,etc.:)
Date Access to Screen Granted: to- zo - fo
Description of historic mining activities or mining material (e.g. tailings, chat, tiff) present on property:
General Comments (visible areas where fill may exist or is suspected):