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SITE MITIGATION PROGRAM CHECKLIST SITE LOCATION: )4 33 fto041,‘ K4m..v..)100 sA._ FA#: 00 7.-9 cieS" pR# es,..ii irad 2-‘461) DATE 4 f_i I 18 ACTIVITY INITIAL \-1 (Ls It g Review submittal and make sure all documents/fees have been submitted. LX 4140 Request documents/fees not submitted. L..- ---8( `Atom I ig ' Provide MFR to Accounting to ensure project has a FA# and a PR#. The PR# for a agency changes, a new PR# must be created under project does not change. If the lead the existing FA. 1 (j Issue SR for Work Plan Review - Enter the data into the SR form in EC making sure L X to link the SR to the related FA. Generate an SR# and document on the permit form. If no no permit form has been submitted, record the information on a golden rod Service Request form. Use this SR# on your DAR to track time spent obtaining documents/ fees, reviewing work plan, issuing permits, coordinating field work activities, reviewing subsequent report/sample results, making notifications/referrals. LI i L,4, Work Plan SR#: 0 0,-10 to i 1./1Y ki l it Review Work Plan to ensure scope of work matches the scope of work approved by construction/destruction meets SJC Ordinance Code the lead agency and that the mw and well standards. 41 ii t l y " Issue Permits - Enter permit information into WP form in EC, link to the FA# for the WP# on DAR to track time spent in the field for the on the permit. L --.Y.' project, and obtain a WP#. Use this specific mw/boring activity specified Li 1 itit, WP#: 0 0.,1<olci Scope: 1 ,. i i_ d ‘ v-,,e, I p ,""on -')(- WP#: Scope: as..ArDia. 6 .• S-6-A-a_ ail 1 WP#: Scope: WP#: Scope: WP#: Scope: After scope of work on the well and boring permit WPs are complete, update the following fields in the Well Permit Approval Dates section of the WP form in EC: Plan Status - choose Finaled'; Final Inspection - enter date permit finaled. After all field work is complete, flag calendar to follow up on report of findings. Report Review: Projects -Review report to determine if present, print out a 5021 and request a 2960. Provide 5021 to Accounting Office for 65 Notification. Send notification letter to CVRWQCB. -Review report to determine next phase of work to appropriate. Complete Prop 65 for any new -Review report to determine if any immediate public health concerns are found, notify supervisor further notifications. Complete Prop 65 for any new Environmental Assessment contamination was found. If contamination new PR# be issued under PE processing. Complete a Prop END Lead Oversight Projects be conducted or if closure is contaminants found at the site. Other Lead Agency Projects health issues are found. If public immediately for follow up and contaminants found at the site. After scope of work for the project SR is complete, update the following fields in the Service Request Approval Dates section of the SR form in EC: Plan Status - choose 'Finaled'; Final Inspection - enter date work finalized. EHD-29 8/15/17 Site Mitigation Program Checklist