Drilling Bid/Estimate Request Form

Please provide us with the following information concerning your project.

It is important to complete as much information as possible so we may expedite your request.

Contact information:

First Name

Last Name

Middle Initial

Title

Organization

Work Phone

FAX

E-mail

If this request is for a Water Well please enter your information above and go to directly to the comments section & submit.

Please complete the following information for Environmental drilling.

Project Name

Project Location Address, City, State, County

Proposed start date of this project -- mm/dd/yy

Estimated number of drilling days?

Abandonment? Yes No

If yes: Number Depth Type Well

Number Depth Type Well

Select ALL of the following drilling conditions:

Asphalt   Concrete  Gravel    Dirt    
Hills

Select ALL of the following concerning permits that apply:

Permits required? Yes No
Permits in place? Yes No

Select one of the following utility options that apply:

All utilities are on site
Water only on site
Electric only on site
No utilities are on site

Surface completion:

Above ground
Flush Mount

Decon required? Yes No

Recommended Rig. Select ALL of the following options that apply:

Auger Only           Air Only      Air Hammer           Mud Rotary 
Combination

Soil Handling:

If drums number required

Enter Monitoring Well Information below:

Number Depth Screen Interval

If additional wells are needed please enter data in comments section below.

Split Spoon Sampling? Yes No

If yes: Split spoon sample interval (feet):

If additional wells are needed please enter data in comments section below.

Comments and additional information: