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SITE MITIGATION PROGRAM CHECKLIST <br />SITE LOCATION: g 1 <br />ti CM-42 ertv•II11- 0 leN <br />FA#: V(213-i Mir PR# 0 S-1-&cz- ,-1 3 ) 2.-(is-v <br />DATE ACTIVITY INITIAL <br />Review submittal and make sure all documents/fees have been submitted. <br />Request documents/fees not submitted. <br />y/f I <br />1 <br />, ty <br />A <br />Provide MFR to Accountinct 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 />(i 1 ,...- <br />0 ii,, <br />Issue SR for Work Plan Review — Enter the data into the SR form in EC making sure <br />L _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 />3s li - Work Plan SR#: 06 ici 5-0 g L <br />I <br />Review Work 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 />c I ,,- <br />u / (5 <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 />specificmw/boring activity specified <br />VI s <br />u r> <br />WP#:„ . <br />(10 .S 5} 65-9 Scope: ..,_ <br />' 1-e-tiwpvt-tArl/ S' VA.(' 0'1 <br />-- el 1,N,' WP#: e- <br />1905V (Air/ <br />Scope: „..--- <br />A ,,- tI 14-> vvp#: <br />os'(010 I <br />scope: ---- <br />S oh \ o) <br />WP#: <br />) ,e4.-- C) ircl (Al,/ <br />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 />El-ID 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 <br /> Site Mitigation Program Checklist