Estimate Request Form
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1. Company Name:
2. Contact Name:
3. Contact Email:
4. Phone:
5. Fax:
6. Project Location:
Address/Intersection:
City/State:
7. Ground Surface:
Concrete
Other (please explain):
Asphalt
8. Project Type (check all that apply):
Environmental
Rock Coring
Regulatory Driven (UST, RCRA, VCUP)
Geotechnical
Real Estate Transaction
Soil Sampling
Well Installation
Other (please explain):
9. Contaminants of Concerns (Environmental Projects):
10: Please Provide a Brief Description of the Project Goals & Objectives:
11. Limited Access or Height Restrictions? (please describe):
12. Geological Conditions (check all that apply):
Alluvium
Fill
Sedimentary/Soft Bedrock
Coluvium
Hard Rock
Glacial Till
Other (please explain):
Gravel/Cobbles
Flowing Sand
13. Number of Borings:
14. Hole Size:
Direct Push:
2 1/8"
Continuous Flight Auger:
6"
4"
Hollow Stem Auger:
6"
9"
13"
-or-      Total Footage:
15. Depth of Borings:
16. Sampling Interval (if applicable):
Other (please explain):
Continuous
5 Ft. Intervals
17. Total Number of Samples (if applicable):
18. Total Number of Monitoring Wells (if applicable):
19. Well Diameter:
4"
1"
2"
6"
20. Length of Well Screen:
21. Screen Slot Size:
0.005
0.020
0.010
Other (please explain):
22. Filter Pack:
6-9
Other (please explain):
10-20
23. Well Seal:
Portland Grout
Bentonite Chips
Granular Bentonite
Other (please explain):
24. Surface Completion:
None
Steel Stick up Casing Protector
8" Flush Mount
Other (please explain):
12" Flush Mount
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