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SITE MITIGATION PROGRAM CHECKLIST ,___, SITE LOCATION: Lc---- 7s-- 1.1,111 4 , 4 I__ ,....,... kJ , v ,--e-i , ,,,-, . 0 v FA#: 007.4-43 7 la PR# 054,2_14732 ~ DATE ACTIVITY INITIAL / S Review submittal and make sure all documents/fees have been submitted. Request documents/fees not submitted. /,4-1 #L,-, Provide MFR MFR to Accounting to ensure project has a ltA# and a PR#. The PR# for a 17 (' 1 ') project does not change. If the lead agency changes, a new PR# must be created under the existing FA. Issue SR for Work Plan Review — Enter the data into the SR form in EC making sure IN 1/ 1 ali' to link the SR to the related FA. Generate an SR# and document on the permit form. If i no permit form has been submitted, record the information on a golden rod Service Ptequest 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. 1_,)( 3 1 igl o Work Plan SR#: op -1% si,s-- L -X ki'11/to Review Work Plan to ensure scope of work matches the scope of work approved by the lead agency and that the mw construction/destruction meets SJC Ordinance Code and well standards. L x Issue Permits - Enter permit information into WP form in EC, link to the FA# for the 1 0 project, and obtain a WP#. Use this WP# on DAR to track time spent in the field for the specific mw/boring activity specified on the permit. L ‘) 1)L1 WP#: (9 0 3 11 ce) Scope: c s-vii 1.% L ---Y. WP#: Scope: 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: Environmental Assessment Projects -Review report to determine if contamination was found. If contamination present, print out a 5021 and request a new PR# be issued under PE 2960. Provide 5021 to Accounting Office for processing. Complete a Prop 65 Notification. Send notification letter to CVRWQCB. END Lead Oversight Projects -Review report to determine next phase of work to be conducted or if closure is appropriate. Complete Prop 65 for any new contaminants found at the site. Other Lead Agency Projects -Review report to determine if any immediate public health issues are found. If public health concerns are found, notify supervisor immediately for follow up and further notifications. Complete Prop 65 for any new 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