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SITE MITIGATION PROGRAM CHECKLIST <br />SITE LOCATION: Z.....q 6s-0 s . Gofcesi /4-0 /Api As2Ar 1 va,zi <br />FA#: tiozVifii pR#190...0.57/3--/ 7 z-q...s-- <br />DATE ACTIVITY INITIAL 7 <br />// Review submittal and make sure all documents/fees have been submitted. <br />Request documents/fees not submitted. / r("--- /;ArdlitilL— <br />X <br />V 1 <br />-2 <br />, <br />Provide MFR to Accounting to ensure project has a FA# and a Pq#. The PR# for a <br />agency changes, a new PR# must be created under project does not change. If the lead <br />the existing FA. <br />"2/ ,2 / <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 />Work Plan SR#: C f.Z.. O-D 7 y <br />3 /f <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 />1410 <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 />LI I 14) <br />WP#: ed ,,, . ,t v Scope: 0 , <br />WP#: Scope: <br />WP#: Scope: <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