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FIELD SERVICES REQUEST <br /> SITE INFORMATION FORM <br /> Identification Pro ect Type Check Aperopriate Category <br /> Project# 778P.432350001-90 ❑X Operation & Maintenance Budget Site Visit <br /> Station ID# ARCO 2133 Sampling Out of Budget Site Visit <br /> Site Address 2908 Ben/amin Holt Dr 1 st Time Visit <br /> Stockton CA E] Quarterly Budget Hours 4 <br /> Lab sequoia _19t _2nd 3rd 4th Actual Hours Z> 1" <br /> County San Joaquin 2 Monthly Mob/de Mob 2 <br /> Project Manager Rusty Benkosky n Semi-Monthly <br /> Requester Brian Carey Weekly Site Safety Concerns <br /> Client Atlantic Richfield Com an One Time Event See Health and Safe Plan <br /> Client P O C Paul Supple Other <br /> Date of Request Field Date 5_J1 a 2— <br /> Field Tasks General Descrl tion <br /> 1 I sample SVE system (bag samples)according to the following schedule <br /> 1 FHg/BTEX(MtBE M <br /> FID M M M <br /> M=Monthly Q Quarter) ,samples=Jan,A ni,July, Nov <br /> Please refer to Work Authorization Number A#)2730100 on each COC for O&M samples. <br /> 2 Collect data <br /> S Complete the data sheet <br /> 4 Call site engineer before leaving site <br /> Comments / Remarks from Field Staff <br /> C pleted By- ]�—{ Date- J o SECOR <br /> Service Hewesta0s Intematfonal incorporated <br />