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FIELD SERVICES REQUEST <br />INFORMATION FORM <br />Identification <br />Project # 077 41991 043 <br />Station ID # Chevron 9-5775 <br />Site Address 301 Kettleman Lane <br />Lodi, CA <br />Lab Koff Analytical <br />County San Joaquin <br />Project Manager fon Chinn <br />Requester Demian Wincele <br />Client Chevron Products Company <br />Client P O C Bob Cochran <br />Date of Request <br />Protect Type <br />rX Operation & Maintenance <br />F] Sampling <br />n 1 st Time Visit <br />F] Quarterly <br />1st 2nd _3rd 4th <br />Monthly <br />Semi -Monthly <br />Weekly <br />One Time Event <br />Other <br />Field Date Wednesdays at 10 am <br />Check Appropriate Cate o <br />QX Budget Site Visa <br />Out of Budget Site Visa <br />Budget Hours <br />Actual Hours <br />Mob/de Mob <br />2/4 <br />2 <br />Site Safety Concerns <br />See Health and Safety Plan <br />Field Tasks General Description <br />1 Sample SVE system (bag samples) according to the following schedule _ <br />W ell Js <br />SVE Influent <br />SVE Effluent <br />PHg/BTEX/MtBE <br />FID Monthl <br />2x per Month <br />2x per Month <br />2x per Month <br />2x per Month <br />2) Sample GWE system (water samples) according to the following schedule <br />r 1-16 J t <br />w0J g -�- <br />TPH TEX18260 I MeKly I mommy moriully I YYGGnI <br />l,$ t.IsrM 1.I0 t -o� f . o0 -- SAM /ie o 7 St <br />Analyze samples by 8260 for oxygenates TBA, MtBE, DIPE, TAME, ETRE, ethanol rnethanal,1,2-DCA, EDS <br />M = monft <br />Q = Quarterty, Quartedy samples = Jan, Apnl, Ju , Nov <br />S Coq site engineer before lea%nng site <br />KV-pnr.$*- q,ecoce Ke<& -W ICS <br />16. ou <br />sem. <br />oP Amu rsw7- <br />t�trL F t � <br />A t I o t`l <br />M U_ I L11 <br />I I$I <br />Y L I(� Atte l <br />�n•� <br />�n1E1� <br />O <br />L� o - <br />I,,\ �C.n <br />1`10 t ti S r*�Ptt7 <br />Completed By <br />Date <br />SECOR <br />In,ematWW 1no&Wated <br />KV-pnr.$*- q,ecoce Ke<& -W ICS <br />