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SITE MITIGATION PROGRAM CHECKLIST <br />SITE LOCATION: I ZA.5- 1,..) . <br />FA#: i 0 0 ez.)..vz3g PR# cr,ELF—Z,0 / 2--ske4.2 <br />DATE ACTIVITY INITIAL <br />Review submittal and make sure all documents/fees have been submitted. <br />Request documents/fees not submitted. <br />liii jig <br />u <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 ,x project does not change. If the lead <br />the existing FA. <br />1,0 i t iris/ <br />Issue SR for Work Plan Review - Enter the data into the SR form in EC making sure <br />Z---Y. — <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 />it iiV [cc 5 6_001 r Work Plan SR#: alt):14+.774,:21_____ <br />CO)0)1,6 <br />Review Work Plan to ensure scope of work matches the scope of work approved by <br />construction/destruction meets SJC Ordinance Code <br />and well standards. <br /> L the lead agency and that the mw <br />if I <br />1(1/11 <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 />-710. 1/4( <br />WP#: Ce 00 3WCUL9 <br />Scope:6-v'e-- 2--1.- 6., eii 1 oti4iwtil-Avte- 6) 41"' )c <br />/hall WP#: <br />0 0 5 Ii5-2-7 Scope: C t..A.41 deskvut.t" 4)1 6'-it-• 49 ''f-L U <br />iil Lill( <br />WP#: act IC S-7-- Scope: i <br />/ 4F-444: 15+1914.4-4ve" (C) ov..A.," 1,....-s_ L.-X <br />/fiiii bf <br />wP#:Scope: <br />00 .(i5-"z1 <br />, <br />i <br />3 --rt iii tictivv4A-1.-. ty wt,./1.-t— 1--- <br />VI 7kg <br />vvp#: 00 31t) Ifil <br />Scope: 1 <br />I Vat ti Ote41"AtkLer". i'd 044.er k9vt• <br />, <br />After scope of work on the well and boring permit WPs are complete, update t e <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 />END 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