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SITE MITIGATION PROGRAM CHECKLIST <br />SITE LOCATION: 3 f <br />FA#: 007-3`110 PR# os-Li ar 1 i 2-q1o0 <br />DATE ACTIVITY INITIAL <br />Review submittal and make sure all documents/fees have been submitted. <br />Request documents/fees not submitted. <br />t <br />itx <br />' <br />1 <br />141 <br />Provide MFR to Accounting to ensure project has a FA# and a PR#. The PR# for a <br />agency changes, a new PR# must be created under L., ...4/ project does not change. If the lead <br />the existing FA. <br />Issue SR for Work Plan Review - Enter the data into the SR form in EC making sure <br />to link the SR to the related FA. Generate an SR# and document on the permit form. If <br />no permit form has been submitted, record the information on a golden rod Service <br />Request form. Use this SR# on your DAR to track time spent obtaining documents/ <br />fees, reviewing work plan, issuing permits, coordinating field work activities, reviewing <br />subsequent report/sample results, making notifications/referrals. <br />let I fi Work Plan SR#:00 ft t .35- 1.... V <br />Review Work Plan to ensure scope of work matches the scope of work approved by <br />construction/destruction meets SJC Ordinance Code the lead agency and that the mw <br />and well standards. <br />Issue Permits - Enter permit information into WP form in EC, link to the FA# for the <br />WP# on DAR to track time spent in the field for the <br />on the permit. <br />project, and obtain a WP#. Use this <br />specific mw/boring activity specified <br />1 1"/P) <br />WP#: 0039Z3g Scope: .--ii <br /> L At <br />t /1,1 in <br />WP#: <br />0031231 <br />Scope: 1 <br />I 1%"0 AA-0-v' We-0 P•I&Chai L.------r <br />ITAihl <br />WP#: oo39,2-,i fo Scope: 1 <br />I ri"Pw l 4-0 wa.4 0.--Eavvi(1 L _).il <br />WP#: Scope: <br />WP#: Scope: <br />After scope of work on the well and boring permit WPs are complete, update the <br />following fields in the Well Permit Approval Dates section of the WP form in EC: Plan <br />Status - choose 'Finaled'; Final Inspection - enter date permit finaled. <br />After all field work is complete, flag calendar to follow up on report of findings. <br />Report Review: <br />Projects -Review report to determine if <br />present, print out a 5021 and request a <br />2960. Provide 5021 to Accounting Office for <br />65 Notification. Send notification letter to CVRWQCB. <br />-Review report to determine next phase of work to <br />appropriate. Complete Prop 65 for any new <br />-Review report to determine if any immediate public <br />health concerns are found, notify supervisor <br />further notifications. Complete Prop 65 for any new <br />Environmental Assessment <br />contamination was found. If contamination <br />new PR# be issued under PE <br />processing. Complete a Prop <br />EHD Lead Oversight Projects <br />be conducted or if closure is <br />contaminants found at the site. <br />Other Lead Agency Projects <br />health issues are found. If public <br />immediately for follow up and <br />contaminants found at the site. <br />After scope of work for the project SR is complete, update the following fields in the <br />Service Request Approval Dates section of the SR form in EC: Plan Status - choose <br />'Finaled'; Final Inspection - enter date work finalized. <br />EHD-29 8/15/17 Site Mitigation Program Checklist