Connelly & Associates - Request a Quote

* Required Fields

Project Name:

Project Location:

County:

State:

Project Number:

*Company:

*Site Contact:

*Cell Phone:

*Contact Name:

*Contact Number:

*Email:

Alternate Contact:

Alternate Number:

Have Location Map:

Yes No

Plans Available:

Miss Utility Ticket No:

Private Locator Required?

Requested Start Date:

Date Cleared By:

Site Conditions:

Grass Paved Gravel/Dirt Lightly Wooded Heavily Wooded
Other:

Slope Conditions:

Flat Slightly Sloped Steeply Sloped

Equipment Requirements:

Truck ATV Tripod Skid Rig

Drilling Method:

2-1/4" H.S.A. 3-1/4" H.S.A. 4-1/4" H.S.A. Mud Rotary

Drilling Requirements:

Hand Clearing	Loader Clearing	Plug Asphalt	Samples used for E.S.A.
Standard Sampling	Extra Samples	Bulk Samples	Undisturbed Samples
Pressuremeter	Rock Coring	Steam Cleaner	Grout Holes
Removal of Excess Spoils from Job Site

Well Data:

Temporary Permanent
Sand Bentonite Flush Protective Cover
Stickup Protective Cover
Hazmat Drums
Permits Required? Yes No

Well Diameter (in.)

Total Number of Borings:

Final Blow Count Should be at Least:

Max Depth:

Total Depth:

Drilling Instructions:

Special Entrance Instructions:

Connelly & Associates
260 Interstate Ct. Frederick, Md 21704

Phone: 301.696.8820 | 800.864.6895 | Fax: 301.696.0327