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FIELD SERVICES REQUEST <br /> MEN <br /> SITE INFORMATION FORM <br /> 113 <br /> Identification Project Type Check A ro riate Cate or <br /> Project# 77OT 43622 01 0010 Operation & Maintenance Budget Site Visit <br /> Station ID # Ranch Market [] Sampling Out of Budget Site Visit <br /> Site Address 23569 South Santa Fe Road F� 1 st Time Visit <br /> Riverbank, CA ❑ Quarterly Budget Hours 4 onsite <br /> Lab KiffAnalytical _1st _2nd _3rd 4th Actual Hours <br /> County San Joaquin _ 0 Monthly Mob/de Mots 3 <br /> Project Manager JaffAuchterlonie ❑ Semi-Monthly <br /> Requester Brian Carex ❑ Weekly Site Safety Concerns <br /> Client Mohamed and Huda Gubary One Time Event <br /> Site P O C Ken Randhawa(Manager) Other <br /> Date of Request Field Date <br /> Field Tasks General Description <br /> 1 Sam le system to following schedule <br /> TPHg/BTEX/MTBE - EPA 82608 M M <br /> . FID M M M <br /> Q = Quarterly M = Monthly <br /> 2) Complete data Sheet _ <br /> 3)Gather well field data(FID,flow rate,vacuum, active ozone wells) . <br /> 4)Call site engineer before leaving site <br /> Comments I Remarks from Field Staff <br /> Completed By ni�i<a Date 10- 10- 02- SECOR <br /> International Incorporated <br />