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FIELD SERVICES REQUEST <br /> SSITE INFORMATION FORM 0 1 L <br /> Identification Prolect Type Check Appropriate Category <br /> Project# 77BP.43235.00 0190X❑ Operation & Maintenance ZX Budget Site Visit <br /> Station ID# ARCO 2133 Sampling ❑ Out of Budget Site Visit <br /> Site Address 2908 Benjamin Holt Or 1st Time Visit <br /> Stockton, CA Quarterly Budget Hours 4 <br /> Lab -Sequoia _1st _2nd _3rd _4th Actual Hours 4 <br /> County San Joaquin ❑X Monthly Mob/de Mob 2 <br /> Project Manager Rusty Benkosky Semi-Monthly <br /> Requester Brian Carey ❑ Weekly Site Safety Concerns <br /> Client Atlantic Richfield Company F1 One Time Event See Health and Safety Plan <br /> Client P O C Paul Supple ❑ Other <br /> Date of Request Field Date 3 dZ <br /> Field Tasks General Description <br /> 7 Sample SVE system(bag samples) according to the following schedule <br /> HEX/MtBE M <br /> FID <br /> M M <br /> M=Monthly Q=Quarterly,samples=Jan,Apnf, July, Nov <br /> Please refer to Work Authorization Number(WA#)2730100 on each COC for O&M samples. <br /> 2) Collect data <br /> 3)Complete the data sheet <br /> 4) Call site engineer before leaving site <br /> Comments/ Remarks from Field Staff <br /> d ' <br /> Completed By: _2 ' Date b SECOR. <br /> Intemettonal Incorporated <br /> wield ServtCa Request x1s <br />