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Project Name

Project Number


Engineer/Project Manager

Field Project Manager

Client Contact Name and Number

Onsite Contact Name and Number

Site Access Notes

Number of Groundwater Check and/or Backfill and/or Disposal of Cuttings

Total Depth Sample Depths Anticipated Laboratory Testing
Boreholes Piezometer Notes Notes

*If permanent piezometers file

Notice Of Intent Form with DWR

*Attach copy of site plan with boring locations

Anticipated Lithology Notes Anticipated Groundwater Notes

Contact Name and Dates Available/

Drilling Company Type of Rig, Auger, and Equipment
Phone Number Scheduled

Utililty Locates
UNCC ticket number Locate meet date and time

Date of call Private locates required?

Date utilities cleared by Private locator name/number

Date clearance expires Date/time of private locate

Utility notes (members cleared, concerns, issues, etc.)

*Attach copy of UNCC email ticket

Date Date Notes
Notice of intent(s) submitted Notice of intent(s) approved

Construction reports due to DWR Construction reports submitted

Permit applications due to DWR Permits approved

Abandonment reports due to DWR Abandonment reports submitted

*Attach copy of the Notice of Intent form(s)

Existing Site Conditions

Ground cover/vegetation

Slope direction and severity

Surface water/drainage features

Bedrock outcrops

Adjacent land use

Existing structures, pavements, and conditions

Photograph numbers (identify photograph number for report cover page), view, direction, and subject

Borehole Relative Elevations, Methodology, and Benchmark used:

Groundwater Measurements
Date Boring Number Depth to Water Total Depth Measurement Point Notes

423968977.xlsx Corporate: 7108 South Alton Way, Building B • Centennial, Colorado 80112
Phone 303-220-0300 •