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FIELD SERVICES REQUEST <br /> SITE INFORMATION FORM <br /> Identification Prolect Type Check Anproorlate cateimonr <br /> Project# 77BP.43210.00.oigo x Operation & Maintenance ❑X Budget Site Visit <br /> Station ID# ARCO 2093 ❑ Sampling Out of Budget Site Visit <br /> Site Address 3435 Tracy Blvd ❑ 1 st Time Visit <br /> Tracy, CA ❑ Quarterly Budget Hours 4 <br /> Lab Se uola _tst _2nd _3rd _4th Actual Hours Z2,D <br /> County San Joa uln []X Monthly Mob/de Mob 2 <br /> Project Manager Rusty Benkos Semi-Monthly <br /> Requester Brian CaTy Weekly Site Safety Concerns <br /> Client. Atlantic Richfield Company F1 One Time Event See Health and Safety Plan <br /> Ciient P O C Paul Su ie [:] Other <br /> Date of Request Field Date 2- <br /> Field Tasks General Description <br /> 11 Sample SVF system(bag samples)according to the following schedule <br /> .c' <br /> y A <br /> TPHgBTDC/MtBE M <br /> FID M M M , <br /> M=Monthly Q=Quarterly,samples=Jan,A dl,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 temporarily turned off <br /> 4 Call site engineer before leaving the site <br /> Comments/ Remarks from Field Staff <br /> `fes <br /> SECOR <br /> Completed By; Date�j'���.� <br /> Intemadonallncorporated <br /> K'1FOfmsV'Ieid`38tVID9 Fiequest.xf9 <br />