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r r <br /> FIELD SERVICES REQUEST <br /> SITE INFORMATION FORM <br /> Identification Projcect Type Check Appropriate Cateaory <br /> Project# 77BP.43235 00 0190 nX Operation & Maintenance 0 Budget Site Visit <br /> Station ID 4 ARCO 2133 El Sampling E] Out of Budget Site Visit <br /> Site Address 2908 Benlamin Holt Dr ❑ 1 st Time Visit <br /> Stockton, CA ❑ Quarterly Budget Hours 4 <br /> Lab Sequoia _1st _2nd _3rd _4th Actual Hours J4"D <br /> County San Joaquin _ FA] Monthly Mob/de Mob 2 <br /> Project Manager Rusty Benkosky Semi-Monthly <br /> Requester Brian Carey Weekly Site Safely Concerns <br /> Client Atlantic Richfield Companx F1 One Time Event See Health and Safety Plan <br /> Client P O C Paul Su le ❑ Other -� <br /> Date of Request Field Date 24 <br /> Field Tasks General Description <br /> i Sample SVE system(bag samples)according to the following schedule <br /> TPHg/BTEX/MtBE M <br /> FID M M M <br /> M= Monthly Q=Quarterly,samples=Jan,April,July, Nov <br /> Please defer to Work Authorization Number A# 2730100 on each COC for O&M samples <br /> -2)Collect data <br /> —3) Complete the data sheet <br /> Call site engineer before leaving site <br /> Comments /Remarks from Field Staff <br /> v <br /> 4-,n <br /> Completed By- - Date: SECOR <br /> Intemadonallncorporated . <br /> K'WOrlt13\FI01d Service Heque5t 7dS <br />