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FIELD SERVICES REQUEST <br /> SITE INFORMATION FORM <br /> Identification Prolect Type Check Approeriate Categam <br /> Project# 778P.43235.00 0190 Operation & Maintenance ❑X Budget Site Visit <br /> Station ID# ARCO 2133 ❑ Sampling Out of Budget Site Visit <br /> Site Address 2908 Benjamin Holt Dr 1 st Time Visit <br /> Stockton CA Quarterly Budget Hours 4 <br /> Lab Sequoia _i st 2nd 3rd 4th Actual Hours <br /> County San Joaquin Monthly Mob/de Mob 2 <br /> Project Manager Rus Benkas Semi-Monthly <br /> Requester _Brian Carey -_ Weekly Site Safety Concerns <br /> Client Atlantic Richfield Company One Time Event See Health and Safe Plan <br /> Client P.O C Paul Supple [] Other <br /> Date of Request Field Date ��— <br /> Field Tasks General Description <br /> 1)Sample SVE system(bag samples)according to the following schedule <br /> EMNIM <br /> TPHg/BTEX(MtBE M <br /> FID M M M <br /> M=Monthly Q=Quarterly,samples=Jan,April,July, Nov <br /> Please refer to Work Authorization Number(WA#)2730100 on each COC for O&M samples. <br /> 2)Collect data <br /> 3)Complete the data sheet <br /> 4)Call site engineer before leaving site <br /> Comments/ Remarks from Field Staff <br /> " mpleted By- -f �Date; z b SECOR <br /> IntemetfonW Incorporated <br /> K. V-IetG Servlce Request XIS <br />