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FIELD SERVICES / O&M REQUEST Work Order # 5304 <br /> Sim INfFCnMATI©N FflFiM <br /> Identification Protect Type <br /> Project# S 10 r0,�_.._-CSL- ❑ 1 st Ttme Visit client P O C <br /> Station # 2 CA 1JC� 1- ❑ Quarterly Date of Request ^ 45 <br /> Site Address 04 - 3" '7�r►} <br /> ❑ 1st ❑ 2nd ❑ 3rd ❑ 4th Ideal field date(s) ZfS— Z Iz�95 <br /> ❑ Monthly <br /> County µ ❑ Semi-Monthly Check Appropriate Category <br /> Project Manager ����� Weekly Budget Hrs <br /> Requestor AvoAj��L4-, X One time event �_S� Actual Hrs r ` <br /> ❑ other <br /> Client _� hMob de Mob �� <br /> Field Tasks: For General Description <br /> circle one <br /> Priority 1 (emergency, must be done within 24 hrs), 2 ( ext visit), 3 (when available) <br /> C'1 _ rterNf5_ QJ T]ZfA-r�t Czoe F~J(z Lz'Ci�5 1S — <br /> z �?Tj M r Cf'RA TIQAJ. _ <br /> L <br /> I <br /> 13/)�J P fzc-�W'o ,mssuG-rs _ <br /> /N FGu&-7vL U 7 <br /> G #n, is �SE?P U 0xf4Q (fin! <br /> _ - FACIli 01,"r-NL 13USA 4,4 CC6// OT ,T.-jr VU Afr-,O Ccs`?)Sz� - Mon //P As <br /> " v <br /> Comments, remarks, etc from Field-Staff (include,problems encountered and out-of-scope work) <br /> — .— ki"For—-— � —�C�..r—T—l �—_ -- -- -- <br /> ❑ Samples taken ❑ Samples not required ❑ Soil vapor ❑ Groundwater <br /> ❑ Weekly ❑ Semi-Monthly ❑ Monthly ❑ Quarterly Se i-An <br /> b <br /> PACIFIC ENVIRONMENTAL GROUP, INC Completed Date <br /> Checked by <br /> White Copv-Originator Yellow Copy 0&M Tech Pink Copy-File <br />