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FIELD SERVICES REQUEST <br /> SITE INFORMATION FORM <br /> Identlflcation Prolea -we Check Approprlate Category <br /> Project# 77BP 43210.00.0190X❑ Operation &Maintenance ❑X Budget Site Visit <br /> Station ID# ARCO 2093 ❑ Sampling ❑ Out of Budget Site Visit <br /> Site Address _5435 Tracy Blvd 1 st Time Visit <br /> Tracy, CA Quarterly Budget Hours 4 <br /> Lab S uola _let _2nd 3rd _4th Actual Hours <br /> County San doa uln- r 0 Monthly Mob/de Mob 2 <br /> Project Manager Rusty Benkasky Semi-Monthly <br /> Requester Brian caret' Weekly Site Safety Concerns <br /> Client. Atlantic Richfield Company .� One Time Event See Health and Safety Plan <br /> Client P O C Paul Supple [] Other <br /> Date of Request Field Date 3111 Q <br /> Field Tasks General Descri tion <br /> 1 Sample SVE system(bag samples)according to the following schedule <br /> TPHg/BTEXIMtBE M <br /> FID I M M M <br /> M=Monthly O=Quarterly,samples=Jan,April,July, Nov <br /> Please refer to Work Authorization Number{WA#)27294 00 on each COC for O&M Samples. <br /> 2)Complete the data sheet <br /> 3 System Is temporanly tumed off <br /> Call site engineer before leaving the site <br /> Comments/Remarks from Field Staff <br /> * ` <br /> S <br /> J�4..� <br /> omple#ed By: �- , Date- SECOR <br /> Intemstlonsl Inoorporated <br /> K. H-leltl Servlae Request ws <br />