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FIELD SERVICES REQUEST <br /> SITE INFORMATION FORM4bperatlQrt & Malrttriance <br /> Identification Proiect Type Check Appropriate Catesory <br /> Project#: 77SP.52133.05.0002 Q Operation & Maintenance Q Budget Site Visit <br /> Station ID#: Chevron 9-4275 ❑ Sampling ❑ Out of Budget Site Visit <br /> Site Address: 2905 W. Benjamin Holt Drive ❑ 1 st Time Visit <br /> Stockton, California ❑ Quarterly Budget Hours: <br /> Lab: N/A 1st _2nd _3rd 4th Actual Hours: <br /> County: San Juaquin FX Monthly Mob/de Mob: <br /> Project Manager. Rusty Benkosky _ ❑ Semi-Monthly <br /> Requester: Sherrie Lang ❑ weekly Site Safety Concerns <br /> Client: Chevron EMC One Time Event See Health and Safety Plan <br /> Client P.O.C: Darin Rouse ❑ Other: <br /> Date of Request: 1-Mar-05 Field Date: <br /> Pre Field Activities <br /> R-7—Toad appropriate field equipment on truck. Read field data sheets to ascertain field equipment needs. <br /> PmDo not perform field work without proper PPE and a HASP. <br /> EjE]f use the new project#and client PM (P.O.C) shown above. <br /> 71 <br /> Aftial Tasks General Description <br /> all site engineer upon arrival (Sherrie Lang ext. 272) and record arrival &departure times. <br /> Complete normal O&M in accordance with industry standards. Complete every field on field data sheets. <br /> Call site engineer prior to leaving site. <br /> Comments 1 Remarks from Field Staff <br /> Meted By: 5-h Date: r �� SECOR <br /> Service Requesuds� International Incorporated <br /> I <br />