school and daycare field sheets o'connor, danny to ... school and daycare field sheets...

_ 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: CelKôrk)

Principal Name & No. Javid- Mrv-.iL. 573- 431 - 33oo Circle one: Cellôjjl

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/oê ; 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


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


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:


/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£>



Property ID: ooo 3

School Name: Coi Pr\ St. Francois County RSE

Address: Ho5 KiUc^f "Drive. T>.-.-e-, Mo Screening Form


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 ;


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


Initials: "Do 4 15T D a t e : l o - p - t o Time: oftSQ


Initials: "Do Date: /Q- a? - to Time: f)^5o

Gravel Area 2 l4

Gravel Area 3 Zo

Gravel Area 4 35


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 _


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: CellôrR)

Other Contact Name & No. T)\<a.ne Schoonovtr Circle one: Cell Work

School Address: 4o5 Hillc>-e5* "D-iê- City & Zip: "Soê. T*.rre. ;n\o (a3t,aB

Mailing Address:^ Attn:

City, State: Zip: . •


"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 WatePÔther:

Number of Students: g f0

Approximate age range: 5 - 8

Is the well shared by another property: Property ED: —


Depth of well: _ Treatment system in use? _ Type {filter, softener,etc.:) —

Date Access to Screen Granted: lo - M - 10



Property ID: ooc>*\

School Name: AJQVUX Middle. Sokooi St. Francois County RSE

Address: 4ok £"a.si- CkesfrKiui- "Iteslocje, MO Screening Form

North Arrow


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.


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


Initials: ^ 6rP D a t e : \ n - L - \ P Time: d23q


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:_


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



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


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


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:


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: _


Depth of well: - Treatment system in use? _ Type (filter,.softener,etc.:)

Date Access to Screen Granted: lo - 4 - 10



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


Pre Post Cell 1


Pre Post Cell 13 /4?


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


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


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 Sôr$

Principal Name & No. tj 573-358- 3271 Circle one: CellôrD

Other Contact Name & No. "D> j ScWooôv/c-r- 573 - fc31 - M ?2- Circle one: Cellôrk^

School Address: 7lk>3 City & Zip: "Rot-v-Ng. Teê. , Mo

Mailing Address: A w a. <LS Attn.

City, State:_ Zip: :


SouViûJesl- 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 .



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


Pre Post Cell I 1365

SamDle Area Post Ex (XXX)

Pre Post Cell 13 8So


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


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 • •


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\

•


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:


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: _


Depth of well: Treatment system in use? — Type (filter, softener, etc. :)

Date Access to Screen Granted: 10 - •M - lo



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


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


Initials: 2D>o 2 fcE Date: lo-~7- Io Ti me: IZ.OO


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


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: •


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



/

Property ID: ooo^

School Name: CmWaA 5CKOQ\

Address: UG, fc-e-beA ~pf\ve. Pc^L- 1+iUs


, Ko Screening Form

North Arrow


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~{-


Initials: "P*> tj fcF Date: lo-f-lo Time: o^op


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/ôerr^ 5TV Mg\- 21, lu Circle one: Cell<ffioh§

Principal Name & No. J.nois, Cc,\iz.wûa ^71 - A 31 - 2-C, I L> Circle one: Cell^cpk


School Address: City & Zip:

Mailing Address: Attn:

City, State: Zip:


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 WaterÔther:

Number of Students: ^,13

Approximate age range: \ 5 - \ %

Is the well shared by another property: __ Property ID:


Depth of well: Treatment system in use? _ Type (filter, softener,etc.:)

Date Access to Screen Granted: !° *V-/o



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}


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


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


Initials: ~Do tcTp" \y l>nto: io_-.Hr 10—. Time: Q%!S


Initials: SM Date: lo /zof io Time: /)3o


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:


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: -


Depth of well: Treatment system, in use? — Type {filter, softener,etc.:)

Date Access to Screen Granted:


ChoT visible oJewig d*Tcb InoeS


Soovc-e. C>( OSC-d

Property ID: Oo }Q

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Property ID: ; oo f[

6 f t School Name:

Address: 2-Q 60-"vf f Jo^-s^k Shr*.e.i-


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


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


Initials: OP <1 CiD Date: lo - U - 10 Time: 113o


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


School Address: 2o So.5Vre<ti- City & Zip: b3^;S

Mailing Address: _• Attn: . .

City. State: _ • Zip:


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



0

Property ID: oo f {

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Property1 ID: OOI2-

School Name: A<~\y /VWf

Address: 3ol f4i't( crest 1'trfc.

St. Francois County1 RSE

Screening Form


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


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: ~


Depth of well : Treatment system in use? Type {filter, softener,etc.:) —

Date Access to Screen Granted: jo -12-10


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***


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


Initials: PO d Date: lO -ii, ~tO Time: //oo


Initials: / Dale: ! 0 f Zi ! f r Q Time! (100

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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



Property Owner: . Mailing Address:

City, State: Zip: •


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: —


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


Pre Post C e ll 1 /DIP"

Cell 2

Cell3 l O l j Cell 4 2 /? 7


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")


Initials: ~Oo £ &S Date: /o -!zl- /o Time:

TH2

TH2

TH2


Initials:

TH2

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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

Property Owner: Mailing Address:

City, State: Zip:


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: —


Depth of well: Treatment system in use? Type (filter, softener,etc.:) —

Date Access to Screen Granted: 10-12 - 10


\f 1 'zihlc c.^f~ nta.r road Uqjy


jZo- i 's d />1 C.t/( *f

Property ID: oO|6

Owner Name: Cafhi

Address: j?Qi


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


Initials: pe? Dale: ) Q ' j Z - l O Time: (5Q&


Initials: Date: (.t [3-< j (h Time: i_LU_0_

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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


City; State: Zip:

tenant owner home work cell



/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: —


Depth of well: _ Treatment system in use? - Type (filler, softener, etc::) -

Date Access to Screen Granted: ! o / z - / o



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


Pre Post Cell ) 1 [

Cell 2 /'£_[_ as$T-

Ccll 3

Cell 4 (7

Cell 3

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Sample Area Post ExiXXXt

Pre Post Cell 6

DW 1

DW 2


Initials: T>e>if. &i3

Garden

Play Area 2

Drip Zone _

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TH 1(6-12") JO TH2_

TH 1(12-18")//^" TH2_

TH 1 (18-24") /^$TH2

Date: lot (3 I/O Tinie: !o3S


Initials:

Date: lo/'S-i/fO Time: / 5 Ot?

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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


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: -


Depth of well: - Treatment system in use? Type (filter, softener,etc.:) —

Date Access to Screen Granted: t o - / S - l o



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


Pre ___ Post

Cell l.J5L?A.

Cell 2 /£ 3

Cell 3 I ? £


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


Initials: T>o d &B. Dale: 10-13-/0 lime: Ufa


Initials:

Date: I 0 / 1 (( o Time: f 1 .3 O

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<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


City, State: Zip: .


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)




Depth of well: Treatment system in use? — Type {filler, softener, etc.:) —

Date Access to Screen Granted: to - /? -to



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

^


Pre Post Cell 1 TV f

Celt 2 ^27

Cell 3 (5 ?

Cell 4

Cell 5


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_


Initials: t>o 4 &B

D a t e : / ° ~ 1 3 - / C Time: /3to


Initials: Date: / o f < ( fd Time: ( 5" 13- <?

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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



Mailing Address:_

Zip:


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- - /&)


Is.the well shared by another property: Property ID:


Depth of well: Treatment system in use? — Type (filter, softener,etc.:) __

Date Access to Screen Granted: to - /% -/p



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



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:


Depth of well: Treatment system in use? Type {filter, softener,etc.:) —

Date Access to Screen Granted: !o - /5 - /o



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


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


Initials: ~P o ('r%

Date: to - / to Time: nfttt


Initials: BM Date: f Time:

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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




City, State: ; Zip:


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:


Depth of well: Treatment system in use? Type (filter, softener,etc.:) —

Date Access to Screen Granted: /£> - 1*1- !Q



Property ID: OQ

Owner Name:

Address:

M tchp./le.

UH Jfi.pCe.rSo/\ Park. ftilksMn


Screening Form

North Arrow

' V


Pre Post Cell 1 22Q 3

Cell 2 5

Cell 3 4^3 '

Cell 4

Cell 5


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


Initials: ~t>o £ 6rB Date: /o - 1*1- fc Time: nfPLP

Play Area I'. 1677

TH1(12-18") TH2_

TH 1(18-24") TH2_


Initials: SlA Dale: lo/2-\|\o Time: 1U2.Q

i VP. Jo. VP. Jo.

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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


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:


Depth of well: Treatment system in use? Type (filter, softener,etc.:)

Date Access to Screen Granted: !o~ f t) - to



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


Pre Post

Cell 1 ILA5

Cell 2 "fop 4

Cell 3 13k??

Cell 4 RS3

Cell 5


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


Initials: T> o d CTR Date: to - H - to Time: ie to


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



Property Owner: Mailing Address: -

City, State: Zip:


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:


Depth of well: Treatment system in use? Type (filter, softener,etc.:)

Date Access to Screen Granted: /b - ftf - /b



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


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


Initials: "Do 4 ts& D a t e : 1 0 - l A - m

Time: II to


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




City, State: Zip:


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



Depth of well: Treatment system in use? Type {filter, softener,etc.:) -

Date Access to Screen Granted: /O" M - to



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


Pre Cell 1 4^~l(g

Post


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

" ^


Initials: *Do 4- drS Date:_ Time:

o-id - lo M3?


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:



Mailing Address:

Zip:


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.\



Depth of well: Treatment system in use? Type {filter, softener,etc.:)

Date Access to Screen Granted: j o - l A - 1 0



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


Pre Post Cell 1 IZ o I

Cell 2

Cell 3

Cell 4

Cell 5


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


Initials:~Pd ^ 6)3 Date: /o - /*j -/o

TH1(12-18") TH2

TH1 (18-24") TH2

Time: \lo3.0


Initials: ftflA Date: lo/zz/io Time: OfflS

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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:



Mailing Address:

Zip:


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)


Is the well shared by another property: Property ID: -—


Depth of well: Treatment system in use? — Type {filter, softener,etc.:) _

Date Access to Screen Granted: /o - /4/- Jn



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


Pre Post

2fcl '


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

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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


City, State: Zip:




£ 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 _ ^ ^


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



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



Property Owner: Mailing Address: f.n. fenv MoT

City, State: , N\o Zip: G>3(o^4


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 )




Depth of well: Treatment system in use? Type (filter, softener,etc.:) ~

Date Access to Screen Granted: |Q - is - io



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


Pre Post Cell 1 ft! 7

Cell 2 1^5 Cell3 IS I

Cell 4

Cell 5


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_


Initials: Po CC Date: !Q - zo - to Time: ftfzo

' Pre Ex Samples Analyzed

Initials: ~p o Date: Jo -Ti me: /SnO

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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



Property Owner: . Mailing Address: !

City, State: • Zip: .


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£)




Depth of well: — Treatment system in use? Type (filter, softener,etc.:)

Date Access to Screen Granted: to- zo - fo



school and daycare field sheets o'connor, danny to ... school and daycare field sheets...

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