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FIELD SERVICES REQUEST <br /> 11�SITE INFORMATION FORM <br /> Identification Prolect Twe Check Appropriate Categoric <br /> Protect# 77B400.0!90 OX Operation & Maintenance [X Budget Site Visit <br /> Station ID# ARCO 2133 [] Sampling Out of Budget Site Visit <br /> Site Address 2908 Ben amin Holt Dr ❑ 1 st Time Visit <br /> Stockton, CA [] Quarterly Budget Hours 4 <br /> Lab Sequoia _tst _2nd _3rd 4th Actual Hoursa <br /> County San Joaquin MX Monthly Mob/de Mob 2 <br /> Protect Manager Rusty Benkos!% ❑ Semi-Monthly <br /> Requester Brian Care [_] Weekly Site Safety Concerns <br /> Client Atlantic Richfield Com an One Time Event See Health and Safety Plan <br /> Client P O C Paul Supple _ ❑ Other <br /> Date of Request Field Date <br /> Field Tasks General Description <br /> 1) Sample SVE system (bag samples)according to the following schedule <br /> TPHg/BTEX/MSE M <br /> FID M M M <br /> M=Monthly Q=Quarterly,samples=Jan,April,July, Nov <br /> Please refer to Work Authorizatlon Number A# 2730100 on each COC for O&M samples. <br /> 2 Collect data <br /> 3 Complete the data sheet <br /> Q Call site engineer before leaving site <br /> Comments / Remarks from Field Staff <br /> Completed By: � _7Date: f r��` SECOR <br /> Intem atlonal Incorporated <br /> elmeld Service Hequest ps <br />