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HomeMy WebLinkAbout6043; PALOMAR AIRPORT ROAD WIDENING AT PASEO DEL NORTE; CALTRANS APPROVED WATER POLLUTION CONTROL PROGRAM -WPCP; 2018-01-31I I Water Pollution Control Program (WPCP) Palomar Airport Road Widening WATER POLLUTION CONTROL PROGRAM (WPCP) For Palomar Airport Road Widening Caltrans Contract Number: Caltrans Project Identifier Number: · Prepared for: Caltrans District 11 4050 Taylor Street San Diego, CA 92110 Submitted by: City of Carlsbad 1635 Faraday Ave. Carlsbad, CA 92008 (760)602-27 40 Proiect Site Address Palomar Airport Road at Paseo Del Norte .I))~ •.·b Contractor's Water Pollution Control (WPC) Manaeer (¾· --1,,o.p ~l /(. /.(' .~ •''i"I V' ''A //✓; ~ V O!o '.P ,~ ~~ David Wiener (760)476-9193 Contractor's Desienated Water Pollution Control Inspector (ifdi(ferent from WPC Manaeer) WPCP Prepared by: Michael Baker International 5050 Avenida Encinas, Suite 260 Carlsbad, CA 92008 I l WPCP Preparation Date January 31, 2018 Water Pollution Control Program (WPCP) Palomar Airport Road Widening Less than 1 acre of soil disturbance. Contents WPCP Template SECTION 10 WPCP Certification and Acceptance Water Pollution Control Program (WPCP) Palomar Airport Road Widening 10.1 Contractor's Certification and Acceptance by the Resident Engineer 10.2 Amendments 10.3 Contractor's Annual Certification and Acceptance by the Resident Engineer SECTION 20 Project and Contractor Information 20.1 Project Description 20.2 Unique Site Features 20.3 Contact Information for Responsible Parties 20.4 Training SECTION 30 Pollution Sources and Control Measures 30.1 Pollutant Sources 30.1.1 Inventory of Materials and Activities that May Pollute Stormwater 30.1.1 Potential Pollutants from Site Features or Known Contaminants 30.2 Soil Stabilization (Erosion Control) and Sediment Control 30.2.1 Soil Stabilization BMPs 30.2.2 Sediment Control BMPs 30.2.3 Tracking Control BMPs 30.2.4 Wind Erosion Control BMPs 30.3 Construction Site Management 30.3.1 Non-Stormwater Management BMPs 30.3.2 Waste Management and Materials Pollution Control BMPs 30.4 Water Pollution Control Drawings (WPCDs) 30.5 Water Pollution Control Schedule SECTION 40 WPCP Implementation 40.1 Water Pollution Control Manager Responsibilities 40.2 Weather Forecast Monitoring 40.3 Best Management Practices Status Report 40.4 Stormwater Site Inspections and Site Visual Monitoring 40.5 Stormwater Site Inspections 40.6 Site Visual Monitoring 40.6.1 Visual Monitoring Prior To a Forecasted Storm Event Water Pollution Control Program (WPCP) Palomar Airport Road Widening 40.6.2 Visual Monitoring During Extended Forecasted Storm Event 40.6.3 Visual Monitoring Within 48 Hours After A Qualifying Rain Event Generating Site Runoff 40.6.4 Visual Monitoring Non-Stormwater Discharges 40.6.5 Visual Monitoring Documentation, Follow-up and Tracking Procedures SECTION 50 WPCP Reporting Requirements 50.1 Record Keeping 50.2 Discharge Reporting 50.3 Regulatory Agency Notice or Order Reporting 50.4 Illicit Connection/Illegal Discharge Reporting WPCP Attachments Attachment A ............................................................................ Water Pollution Control Drawings Attachment B ........................................................................... Water Pollution Control Schedule Attachment C .............................................................................................. WPCP Amendments Attachment D ........................................................................ Stormwater Training Documentation WPCP Appendices Appendix A Appendix 8 Appendix C Appendix D Appendix E Appendix F Appendix G Appendix H Appendix I Appendix J Appendix K ....................... CEM-2008 SWPPP/WPCP Amendment Certification and Acceptance .......................................................... CEM-2009 SWPPP/WPCP Amendments Log ................................................................... CEM-2023 Stormwater Training Record ....................................................... CEM-2024 Stormwater Training Log -Optional ................................................................................................. No longer needed .. CEM-2034 Monthly Stormwater Best Management Practices and Materials Inventory Report -Optional ......................................................... CEM-2030 Stormwater Site Inspection Report ................................................ CEM-2035 Stormwater Corrective Actions Summary .................................................................... CEM-2061 Notice of Discharge Report ................................................................................................. No longer needed .................................. CEM-2070 SWPPP/WPCP Annual Certification of Compliance l SECTION 10 WPCP Certification and Acceptance Water Pollution Control Program (WPCP) Palomar Airport Road Widening 10.1 Contractor's Certification and Acceptance by the Resident Engineer WPCP PREPARER CERTIFICATION OF WPCP "I certify that I have the qualifications and certifications specified for a Qualified SWPPP Developer (QSD) or Qualified SWPPP Practinoner (QSP) shown in the National Pollutant Discharge Elimination System (NPDES) General Permit for Storm Water Discharges Associated with Construction and Land Disturbance Activities, Order No. 2009- 0009-DWQ, NPDES No.CAS000002, Section VII, Training Qualifications and Certification Requirements. I certify that this WPCP meets the requirements set forth in the contract special provisions, Caltrans Standard Specifications, and the Caltrans SWPPP/WPCP Preparation Manual. I certify under a penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to ensure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted, to the best of my knowledge and belief is true, accurate, and complete. I am aware that there are significant penalties fo r submitting false information, including the possibility of fine and imprisonment for knowing violations." /µ ~ March 15, 2018 WPCP Preparer Signature Date David Wiener (760) 603-6252 WPCP Preparer Name Telephone Number Civil Engineer WPCP Preparer Title CONTRACTOR'S CERTIFICATION OF WPCP "I certify under a penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to ensure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted, to the best of my knowledge and belief is true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." Contractor's Signature Contractor's Name Contractor's Title City of Carlsbad WPCP Template 5/6/2016 1/31/2018 Date Telephone Number WPCP Certification and Acceptance Page 10-1 f J For Use by Caltrans Only Water Pollution Control Program (WPCP) Palomar Airport Road Widening CAL TRANS RESIDENT ENGINEER'S ACCEPTANCE OF WPCP "I certify under a penalty of law that this document and all attachments were reviewed under my direction or supervision in accordance with a system designed to ensure that qualified personnel properly evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted, to the best of my knowledge and belief is true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." This WPCP is accepted based on a review performed by myself or personnel acting under my direction. that detrermined that the WPCP meets the requirements set forth in the contract special provisions, Caltrans Standard Specifications, and the Caltrans SWPPP/WPCP Preparation Manual. Resident Engineer's Signature Date Resident Engineer's Name Telephone Number 10.2 Amendments The WPCP shall be amended whenever there is a change in construction or operations that may cause the discharge of significant quantities of pollutants to surface waters, ground waters, municipal storm drain systems, or when deemed necessary by the Resident Engineer. The WPCP must be amended when: • changes in work activities could affect the discharge of pollutants • WPC practices are added by contract change order • WPC practices are added at the contractor's discretion Amendments to WPCP shall be documented in letter format and include revised Water Pollution Control Drawing sheets, as appropriate. WPCP amendments shall be certified by the contractor and require acceptance by Caltrans or Local Agency I Private Entity Resident Engineer. For encroachment permit projects, Caltrans Oversight Engineer concurrence is required. Documentation of WPCP amendment certification, acceptance and Cal trans Oversight Engineer concurrence, if required will be documented using CEM-2008 SWPPP/WPCP Amendment Certification and Acceptance form in Appendix A. All WPCP amendments shall be documented on CEM-2009 SWPPP/WPCP Amendments Log which includes: • . amendment number • amendment date • brief description of the amendment • name of individual requesting amendment City of Carlsbad WPCP Template 5/6/2016 1/31/2018 WPCP Certification and Acceptance Page 10-2 • amendment acceptance date . Water Pollution Control Program (WPCP) Palomar Airport Road Widening All WPCP amendments shall be logged on CEM-2009 SWPPP/WPCP Amendment Log form, in Appendix B. Accepted amendments with an updated amendment log shall be attached to the contractor's on-site WPCP in 10.3 Contractor's Annual Certification and Acceptance by the Resident Engineer Each year by July 15 the contractor shall certify that the water pollution control measures are being implemented in accordance with the accepted WPCP for the project, including accepted WPCP amendments. The contractor shall submit the annual certification to the Resident Engineer for acceptance. Documentation of annual certification shall be on CEM-2070 SWPPP/WPCP Annual Certification of Compliance form, in Appendix K. City of Carlsbad WPCP Template 5/6/2016 1/31/2018 WPCP Certification and Acceptance Page 10-3 [ l SECTION 20 Project and Contractor Information 20.1 Project Description Water Pollution Control Program (WPCP) Palomar Airport Road Widening The construction project is located in the County of San Diego, City of Carlsbad, east of the Interstate 5. The project proposes to widen eastbound Palomar Airport Road to accommodate a dedicated right-tum lane onto Paseo Del Norte and create a new bike lane. The proposed widening results in demolition of a portion of the existing sidewalk and commercial driveways, relocation of street lights, construction of a new sidewalk and driveways, grading, and re- landscaping. The downstream receiving water from the project site is the Pacific Ocean. Dranage patterns will not change as a result of the project. Runoff will still be captured in the curb & gutter, flowing west along Palomar Airport Road and discharges into an existing vegetated area south of the project site via a concrete brow ditch. 20.2 Unique Site Features There are no other unique site features within or adjacent to the project site boundary. 20.3 Contact Information for Responsible Parties Resident Engineer Name: Title: Company: Address: Phone Number: Emergency Phone Number (24/7) Email address: Contractor Name: Title: Company: Address: City of Carlsbad WPCP Template 5/6/2016 Resident Engineer Caltrans District 11 4050 Taylor Street San Diego, CA 92110 City of Carlsbad 1635 Faraday Ave. 1/31/2018 Project and Contractor Information Page 20-1 { [ l Phone Number: Emergency Phone Number (24/7) Email address: Carlsbad, CA 92008 (760)602-2740 Water Pollution Control Manager (WPC Manager) Name: Title: Company: Address: Phone Number: David Wiener Project Engineer Michael Baker International 5050 Avenida Encinas, Suite 260 Carlsbad, CA 92008 (760)476-9193 Emergency Phone Number (24/7): (760)476-9193 Email address: dwiener@mbakerintl.com Erosion and Sediment Control Provider Name: Title: Company: Address: Phone Number: Emergency Phone Number (24/7) Email address: 20.4 Training Water Pollution Control Program (WPCP) Palomar Airport Road Widening David Wiener, the WPC Manager for this project, meets the Qualified SWPPP Practioner (QSP) registration or certification requirement of Section VII., "Training Qualifications and Certification Requirements," of the Construction General Permit based on: • Qualified SWPPP Developer/Practitioner, CA (Certificate #20077) The WPC Manager has received the following training: City of Carlsbad WPCP Template 5/6/2016 1/31/2018 Project and Contractor Information Page 20-2 l r [ • QSD/QSP Training Course Water Pollution Control Program (WPCP) Palomar Airport Road Widening The WPC Manager has the following WPCP development and implementation experience: • Fairbanks Ranch Gate Improvements, Rancho Santa Fe, CA 2012 • La Costa Resort & Spa, Adult Pools and Waterline Relocation, Carlsbad, CA 2011 • Vista Hermosa Park, San Clemente, CA 2011 • Rock Springs Road/ Richland Road Street Improvements Project, San Marcos, CA 2010 The WPCP for this project was developed by David Wiener, who meets the Qualified SWPPP Practioner (QSP) registration or certification requirement of Section VII., "Training Qualifications and Certification Requirements," of the Construction General Permit based on: • Qualified SWPPP Developer!Practitioner, CA (Certificate #20077) The QSP has received the following training: • QSD / QSP Training Course (Certificate #20077) The QSP has the following WPCP development experience: • Fairbanks Ranch Gate Improvements, Rancho Santa Fe, CA 2012 • La Costa Resort & Spa, Adult Pools and Waterline Relocation, Carlsbad, CA 2011 • Vista Hermosa Park, San Clemente, CA 2011 • Rock Springs Road/ Richland Road Street Improvements Project, San Marcos, CA 2010 Contractor or subcontractor employees responsible for water pollution control best management practices (BMPs) installation, maintenance and repair have received the following training: • Contractor and subcontractor employees shall be trained prior to working on the site in the following subjects: • water pollution control rules and regulations. • implementation and maintenance for: o temporary soil stabilization o temporary sediment control o tracking control o wind erosion control o material pollution prevention control City of Carlsbad WPCP Template 5/6/2016 1/31/2018 Project and Contractor Information Page 20-3 f f { [ l l o waste management 0 non-storm water management • identifying and handling hazardous substances Water Pollution Control Program (WPCP) Palomar Airport Road Widening • potential dangers to humans and the environment from spills and leaks or exposure to toxic or hazardous substances Informal employee training shall include tailgate site meetings to be conducted weekly and address the following topics: • water pollution control best management practices (BMPs) deficiencies and corrective actions • BMPs that are required for work activities during the week • spill prevention and control • material delivery, storage, use, and disposal • waste management • non-stormwater management A summary of formal and informal training of various personnel is shown in Attachment D. A copy of all training certificate(s) for the WPC Manager and the WPCP Preparer are included in Attachment D. Stormwater training for project personnel shall be documented on form CEM-2023 Stormwater Training shown in Appendix C. For each training occurance, both a training record and an updated training log, form CEM-2024 Stormwater Training Log.shown in Appendix D, must be completed. A copy of the training log, training record and copies of all training certificates for project personnel will be kept in WPCP file category 20.23 Contractor Personnel Training Documentation. An updated trainig log and documentation of new training shall be submitted to the RE within 5 days of training. City of Carlsbad WPCP Template 5/6/2016 1/31/2018 Project and Contractor Information Page 20-4 l l [ ( SECTION 30 Water Pollution Control Program (WPCP) Palomar Airport Road Widening Pollution Sources and Control Measures 30.1 Pollutant Sources 30.1.1 Inventory of Materials and Activities that May Pollute Stormwater The following is a list of construction materials that will be used and activities that will be performed that will have the potential to contribute pollutants, other than sediment, to stormwater runoff: • Asphalt Concrete • Portalnd Cement Concrete The following is a list of construction activities that have the potential to contribute sediment to stormwater discharges include: • Hardscape Demolition (Parking areas, curbs, gutter, sidewalks) • Clearing and Grubbing • Grading Activities • Stockpiling • Saw Cutting • Paving and Grinding • Concrete Placement • Concrete Waste Management • Material Delivery and Storage • Solid Waste Management (litter, trash, and debris) • Liquid Waste Management (wash water) 30.1.2 Potential Pollutants from Site Features or Known Contaminants Existing site features that, as a result of past usage, may contribute pollutants to storm water ( e.g., toxic materials that are known to have been treated, stored, disposed, spilled, or leaked onto the construction site) include: • None The following contaminants are known to exist at the project site locations identified: • Sediment City of Carlsbad WPCP Template 5/6/2016 1/31/2018 Pollution Sources and Control Measures Page 30-1 r ( ( [ { [ f { · { • • • • • • • • Nutrients Heavy Metals Organic Compounds (including petroleum hydrocarbons) Trash & Debris Oxygen Demanding Substances (including solvents) Oil & Grease Bacteria & Viruses Pesticides Water Pollution Control Program (WPCP) Palomar Airport Road Widening 30.2 Soil Stabilization (Erosion Control) and Sediment Control 30.2.1 Soil Stabilization BMPs The following soil stabilization BMP implementation table indicates the BMPs that shall be implemented to control erosion on the construction site. Implementation and locations of temporary soil stabilization BMPs are shown on the WPCDs in Attachment A and described in this section. Any additional BMP detail drawing necessary to convey site specific BMP configuations can also be found in Attachment A of this WPCP. The following list ofBMPs and narrative explain how the selected BMPs will be incorporated into the project. TEMPORARY SOIL STABILIZATION BMPs CONSTRUCTION BMP NAME BMP ID NO.(1 SS-1 Scheduling SS-2 Preservation of Property/ Preservation of Existing Vegetation SS-3 Bonded Temporary Hydraulic Mulch (Bonded Stabilized Fiber Matrix) SS-3 Polymer Temporary Hydraulic Mulch (Polymer Stabilized Fiber Matrix) SS-4 Temporary Erosion Control (With Temporary Seeding) SS-5 Temporary Soil Stabilizer SS-6 Temporary Erosion Control (Straw Mulch with Stabilizing Emulsion) City of Carlsbad WPCP Template 5/6/2016 CONTRACT CONTRACT MIN BID ITEM REQUIRE- MENT(2) ~ □ ~ □ ~ □ ~ □ ~ □ ~ □ ~ □ 1/31/2018 BMP USED IF A CONTRACT MINIMUM Yes @ @ 0 0 0 0 0 REQUIREMENT BUT NOT USED, STATE REASON No 0 0 Not required for project @ Not required for project @ Not required for project @ Not required for project @ Not required for project @ Pollution Sources and Control Measures Page 30-2 r l ( l ( SS-7 Slope Temporary Erosion Control Blanket (On Slope) ~ SS-7 Swale Temporary Erosion Control Blanket (In swale or ditch) □ SS-7 Geotextile Temporary Cover (Geotextiles and Mats) ~ SS-8 Temporary Mulch (Wood) □ SS-9 Earth Dikes/ Drainage Swales & Lined Swales □ SS-10 Outlet Protection / Velocity Dissipation Devices □ SS-11 Slope Drains □ SS-12 Streambank Stabilization □ □ 0 □ 0 □ 0 □ 0 □ 0 □ 0 □ 0 □ 0 Water Pollution Control Program (WPCP) Palomar Airport Road Widening Not required for project @ @ Not required for project @ @ @ @ @ @ ALTERNATIVE TEMPORARY SOIL STABILIZATION BMPs USED 13) 0 Yes @ No Notes: (1)The BMP designations (SS-1, SC-3, etc.) are solely for maintaining continuity with existing Caltrans documents and are not provided to imply that the Construction Site Best Management Practices (BMPs) Reference Manual is a required contract document. (2)Minimum requirements are based on the required contract plans and specifications. Not all minimum requirements may be applicable to every project. Applicability to a specific project shall be determined by the WPCP Preparer or WPC Manager. (3)Use of alternative BMPs will require written approval by the Resident Engineer SS-1 Scheduling The project schedule shall sequence construction activities with the installation of both soil stabilization and sediment control measures. The construction schedule will be arranged as much as practicable to leave soil undisturbed until immediately prior to clearing/grading. SS-2 Preservation of Existing Vegetation The project will preserve existing vegetation at areas where no construction activity is planned. 30.2.2 Soil Stabilization BMPs The following sediment control BMP implementation table indicates the BMPs that shall be implemented to control sediment on the construction site. Implementation and locations of temporary sediment control BMPs are shown on the WPCDs in Attachment A and described in this section. Any additional BMP detail drawings necessary to convey site specific BMP configurations can also be found in Attachment A of this WPCP. The following list of BMPs and narrative explain how the selected BMPs will be incorporated into the project. TEMPORARY SEDIMENT CONTROL BMPs ----------~ City of Carlsbad WPCP Template 5/6/2016 1/31/2018 Pollution Sources and Control Measures Page 30-3 r CONSTRUCTION BMP NAME CONTRACT BMP ID NO.(1 MIN REQUIRE- MENT(2l SC-1 Temporary Silt Fence ~ SC-2 Temporary Sediment Basin □ SC-4 Temporary Check Dam □ SC-5 Temporary Fiber Rolls ~ SC-6 Temporary Gravel Bag Berm □ SC-7 Street Sweeping ~ SC-8 Temporary Sandbag Barrier □ SC-9 Temporary Straw Bale Barrier □ SC-10 Temporary Drain Inlet Protection ~ CONTRACT BID ITEM ~ □ □ □ ~ ~ □ □ ~ Water Pollution Control Program (WPCP) Palomar Airport Road Widening BMP USED IF A CONTRACT MINIMUM REQUIREMENT BUT NOT USED, STATE REASON Yes No @ 0 0 @ 0 @ Not required for project 0 @ @ 0 @ 0 0 @ 0 @ @ 0 ALTERNATIVE SEDEMENT CONTROL BMPs USED (3l 0 Yes @ No Notes: (1 )The BMP designations (SS-1, SC-3, etc.) are solely for maintaining continuity with existing Caltrans documents and are not provided to imply that the Construction Site Best Management Practices (BMPs) Reference Manual is a required contract document. (2)Minimum requirements are based on the required contract plans and specifications. Not all minimum requirements may be applicable to every project. Applicability to a specific project shall be determined by the WPCP Preparer or WPC Manager. (3)Use of alternative BMPs will require written approval by the Resident Engineer Refer to Attachment A -Water Pollution Control Drawings for the location of soil-disturbed areas that will need sediment control BMPs. 30.2.3 Tracking Control BMPs The following tracking control BMP implementation table indicates the BMPs that shall be implemented to reduce sediment tracking from the construction site onto private or public roads. Implementation and locations of tracking control BMPs are shown on the WPCDs in Attachment A and described in this section. Any additional BMP detail drawings necessary to convey site specific BMP configurations can also be found in Attachment A of this WPCP. The following list ofBMPs and narrative explain how the selected BMPs will be incorporated into the project. City of Carlsbad WPCP Template 5/6/2016 TEMPORARY TRACKING CONTROL BMPs 1/31/2018 Pollution Sources and Control Measures Page 30-4 CONSTRUCTION BMP NAME CONTRACT CONTRACT BMP ID NO.(1 MIN BID ITEM REQUIRE- MENT!2l SC-7 Street Sweeping □ □ TC-1 Temporary Construction Entrance □ □ TC-2 Stabilization Construction Roadway □ □ TC-3 Temporary Entrance / Outlet Tire Wash □ □ ALTERNATIVE TRACKING CONTROL BMPs USED(3l 0 Yes @ No Notes: Water Pollution Control Program (WPCP) Palomar Airport Road Widening BMP USED IF A CONTRACT MINIMUM REQUIREMENT BUT NOT USED, STATE REASON Yes No @ 0 0 @ 0 @ 0 @ (1 )The BMP designations (SS-1, SC-3, etc.) are solely for maintaining continuity with existing Caltrans documents and are not provided to imply that the Construction Site Best Management Practices (BMPs) Reference Manual is a required contract document. (2)Minimum requirements are based on the required contract plans and specifications. Not all minimum requirements may be applicable to every project. Applicability to a specific project shall be determined by the WPCP Preparer or WPC Manager. (3)Use of alternative BMPs will require written approval by the Resident Engineer SC-7 Street Sweeping Street sweeping will occur to reduce sediment tracking from the construction site onto public roads. 30.2.4 Wind Erosion Control BMPs The following wind erosion control BMP implementation table indicates the BMPs that shall be implemented to control wind erosion on the construction site. Implementation and locations of wind erosion control BMPs are shown on the WPCDs in Attachment A and/or described in this section. The following list ofBMPs and narrative explain how the selected BMPs shall be incorporated into the project. TEMPORARY WIND EROSION CONTROL BMPs CONSTRUCTION BMP NAME BMP ID NO.(1 WE-1 Wind Erosion Control TC-1 Temporary Construction Entrance TC-2 Stabilization Construction Roadway City of Carlsbad WPCP Template 5/6/2016 CONTRACT CONTRACT MIN BID ITEM REQUIRE- MENT!Zl ~ □ □ □ □ □ 1/31/2018 BMP USED IF A CONTRACT MINIMUM Yes @ 0 0 REQUIREMENT BUT NOT USED, STATE REASON No 0 @ @ Pollution Sources and Control Measures Page 30-5 ---All Soil Stabilization Measures included in □ Section 30.2.1 □ @ Water Pollution Control Program (WPCP) Palomar Airport Road Widening 0 ALTERNATIVE WIND EROSION CONTROL BMPs USED 13) 0 Yes @ No Notes: (1 )The BMP designations (SS-1 , SC-3, etc.) are solely for maintaining continuity with existing Caltrans documents and are not provided to imply that the Construction Site Best Management Practices (BMPs) Reference Manual is a required contract document. (2)Not all minimum requirements may be applicable to every project. Applicability to a specific project shall be determined by the contractor and approved by the Resident Engineer. (3)Use of Alternative BMPs will require written approval by the Resident Engineer. WE-1 Wind Erosion Control Portable water shall be applied to disturbed soil areas to control dust and maintain optimum moisture levels for compaction. The water will be applied using water trucks. Water application rates will be minimized as necessary to prevent runoff and ponding, and any leaks from water equipment will be repaired immediately. 30.3 Construction Site Management 30.3.1 Non-Stormwater Management BMPs The following BMP implementation table indicates the BMPs that have been selected to control non-stormwater pollution on the construction site. Implementation and locations of non-stormwater control BMPs are shown on the WPCDs in Attachment A and described in this section. Any additional BMP detail drawings necessary to convey site specific BMP configurations can also be found in Attachment A of this WPCP. Construction Site Management Non-Stormwater Pollution Control BMPs CONSTRUCTION BMP NAME BMP ID NO.11 NS-1 Water Control and Conservation NS-2 Dewatering (3) NS-3 Paving, Sealing, Sawcutting, and Grinding Operations NS-4 Temp Stream Crossing (3) NS-5 Clear Water Diversion (3) City of Carlsbad WPCP Template 5/6/2016 CONTRACT CONTRACT MIN BID ITEM REQUIRE- MENT!2) □ □ □ □ □ □ □ □ □ □ 1/31/2018 BMP USED IF A CONTRACT MINIMUM Yes @ 0 @ 0 0 REQUIREMENT BUT NOT USED, STATE REASON No 0 @ 0 @ @ Pollution Sources and Control Measures Page 30-6 NS-6 Illegal Connection and Illegal Discharge Detection ~ Reporting NS-7 Potable Water/ Irrigation □ NS-8 Vehicle and Equipment Cleaning ~ NS-9 Vehicle and Equipment Fueling ~ NS-10 Vehicle and Equipment Maintenance ~ NS-11 Pipe Driving Operations □ NS-12 Concrete Curing □ NS-13 Material and Equipment Used Over Water □ NS-14 Concrete Finishing □ NS-15 Structure Demolition/ Removal Over or Adjacent □ to Water □ @ □ @ □ @ □ @ □ @ □ 0 □ 0 □ 0 □ 0 □ 0 Water Pollution Control Program (WPCP) Palomar Airport Road Widening 0 0 0 0 0 @ @ @ @ @ ALTERNATIVE NON-STORMWATER POLLUTION CONTROL BMPs USED(4l 0 Yes @ No Notes: (1 )The BMP designations (SS-1, SC-3, etc.) are solely for maintaining continuity with existing Caltrans documents and are not provided to imply that the Construction Site Best Management Practices (BMPs) Reference Manual is a required contract document. (2)Not all minimum requirements may be applicable to every project. Applicability to a specific project shall be determined by the contractor and approved by the Resident Engineer. (3)The BMPs listed above are incidental and do not include operations included as separated line items in the contract. (4)Use of alternative BMPs will require written approval by the Resident Engineer NS-1 Water Control and Conservation Water application rates will be minimized, as necessary, to prevent runoff and ponding and water equipment leaks will be replaced immediately. Watering times and schedules will be adjusted to ensure that the appropriate amount of water is being used and to minimize runoff. NS-3 Paving, Sealing, Sawcutting, and Grinding Operations The project will include placement of approximately 33,500 square feet of pavement, with 10,250 square feet within the Caltrans right-of-way. Paving locations and adjacent curb inlets are shown on Attachment A -WPCDs. Paving and Grinding Operation BMPs will be implemented to prevent paving materials from being discharged off site. Curb inlets within proximity of the AC paving areas will be temporarily covered as shown on the WPCDs. Following paving City of Carlsbad WPCP Template 5/6/2016 1/31/2018 Pollution Sources and Control Measures Page 30-7 Water Pollution Control Program (WPCP) Palomar Airport Road Widening operations, the area will be swept, inlet covers will be removed, and inlets will be inspected for paving materials. Saw- cutting opperations should not be conducted during or immediately prior to rainfall events. The slurry shall be vacuumed and discharged to the concrete washout facilities. Dried and cured concrete wastes shall be disposed off site during concrete washout maintenance activities. NS-6 Illegal Connection and Illegal Discharge Detection Reporting The contractor will implement the Illegal Connection/Illegal Discharge Detection Reporting BMP throughout the duration of the project. NS-8, NS9, NS-10 Vehicle Equipment Operations Several types of vehicle and equipment will be used on site throughout the project, including graders, scrapers, excavators, loaders, paving equipment, roller, trucks and trailer, forklifts and traffic control equipment. Vehicle and equipment fueling, and vehicle equipment maintenance BMPs will be utilized to prevent discharge of fuel and other vehicle fluids. All wheeled vehicles shall be fueled offsite. Fuel trucks, each equipped with absorbent spill clean-up materials, shall be used for all on-site fueling, whether at the temporary fueling area or for mobile fueling elsewhere on the site. Drip pans shall be used during all mobile fueling. Drip pans or absorbent pads shall be used during all vehicle equipment maintenance activities that involve grease, oil, solvents, or other vehicle fluids. All vehicle maintenance and mobile fueling operations shall be conducted at least 50 feet away from operational inlets and drainage facilities and on a level, graded area. 30.3.2 Waste Management and Materials Pollution Control BMPs The following BMP implementation table indicates the BMPs that have been selected to control pollutants from construction site wastes and materials. Implementation and locations of materials handling and waste management BMPs are shown on the WPCDs in Attachment A. Any additional BMP detail drawings necessary to convey site specific BMP configurations can also be found in Attachment A of this WPCP. The following list ofBMPs and narrative explain how the selected BMPs will be incorporated into the project. Construction Site Management Waste Management and Materials Pollution Control CONSTRUCTION BMP NAME BMP ID NO.(1 WM-1 Material Delivery and Storage WM-2 Material Use WM-3 Stockpile Management WM-4 Spill Prevention and Control WM-5 Solid Waste Management City of Carlsbad WPCP Template 5/6/2016 BMPs CONTRACT CONTRACT MIN BID ITEM REQUIRE- MENT!2l ~ □ ~ □ ~ □ ~ □ □ □ 1/31/2018 BMP USED IF A CONTRACT MINIMUM Yes @ @ @ @ @ REQUIREMENT BUT NOT USED, STATE REASON No 0 0 0 0 0 Pollution Sources and Control Measures Page 30-8 WM-6 Hazard Waste Management (3) WM-7 Contaminated Soil Management (3) WM-8 managed Concrete Waste Management WM-8 temporary Temporary Concrete Washout Facility WM-8 portable Temporary Concrete Washout (Portable) WM-9 Sanitary/Septic Waste Management WM-10 Liquid Waste Maintenance □ □ □ □ □ □ □ □ □ □ ~ □ □ □ 0 0 @ 0 @ @ @ Water Pollution Control Program (WPCP) Palomar Airport Road Widening @ @ 0 @ 0 0 0 ALTERNATIVE WASTE MANAGEMENT AND MATERIALS POLLUTION CONTROL BMPs USED (4) 0 Yes @ No Notes: (1 )The BMP designations (SS-1, SC-3, etc.) are solely for maintaining continuity with existing Caltrans documents and are not provided to imply that the Construction Site Best Management Practices (BMPs) Reference Manual is a required contract document. (2)Not all minimum requirements may be applicable to every project. Applicability to a specific project shall be verified by the contractor and approved by the Resident Engineer. (3)The BMPs listed above are incidental and do not include operations included as separated line items in the contract. (4)Use of alternative BMPs will require written approval by the Resident Engineer. WM-1 Material Delivery and Storage The general material storage area shall be located in the Contractor's staging area. A sandbag barrier shall be provided around the storage area to prevent run-on from adjacent areas. WM-3 Stockpile Management Stockpile management shall be implemented to reduce or eliminate pollution of stormwater from stockpiles of soil and paving materials such as PCC rubble, AC, AC rubble, aggregate base, aggregate subbase, pre-mixed aggregate and asphalt binder. Stockpiles shall be surrounded with sediment controls (BMP SC-5 Fiber rolls or SC-8 sandbag barrier). WM-4 Spill Prevention and Control Spill Prevention and Control shall be implemented to contain and clean up spills and prevent material discharges to the drainage system. WM-5 Solid Waste Management Solid Waste Management shall be implemented to minimize stormwater contact with waste materials and prevent discharges. Solid wastes shall be loaded directly onto trucks for off-site disposal. When on-site storage is necessary, solid wastes shall be stored on watertight dumpsters in the general storage area. City of Carlsbad WPCP Template 5/6/2016 1/31/2018 Pollution Sources and Control Measures Page 30-9 WM-8 Concrete Residual and Washout Wastes Water Pollution Control Program (WPCP) Palomar Airport Road Widening Discharge will consist of rinse water and residual concrete (PCC, aggregates, admixtures and water). Concrete waste management activities shall be implemented in accordance with contract documents. All excess concrete and concrete washout slurries shall be discharged to the washout facility for drying. WM-9 Sanitary and Septic Wastes The Contractor shall implement a Sanitary and Septic Waste Management BMP. The toilets shall be located away from concentrated flow paths and traffic flow. WM-10 Liquid Waste Maintenance Liquid waste management shall be implemented to prevent discharge of pollutants to the drainage system as a result of the disposal of non-hazardous liquid waste. 30.4 Water Pollution Control Drawings (WPCDs) The Water Pollution Control Drawings (WPCDs) show the necessary BMPs by project phase/stage for the project to be in compliance with water pollution control requirements. The WP CDs provide field staff with the information on where to install BMPs so that they are effective. The WPCDs and Water Pollution Control Schedule provide the necessary tools for a contractor to plan and implement BMPs to meet the requirements of the project WPCP. The WPCD cover sheet(s) shall include a listing of the BMPs that will be used along with the associated BMP symbols used on the WPCDs. WPCDs are provided for all areas that are directly related to the construction activity, including but not limited to staging areas, storage yards, material borrow areas and storage areas, access roads, etc., whether or not they reside within the Caltrans rights-of-way. The WPCDs shall show the construction project site in detail, including: • construction site perimeter • geographic features within or immediately adjacent to the site, including surface waters such as lakes, streams, springs, wetlands, estuaries, ponds, and the ocean • site topography before and after construction, including roads, paved areas, buildings, slopes, drainage facilities, and areas of known or suspected contamination • permanent (post-construction) BMPs The WPCDs shall show the following site information: • discharge points from the project to offsite storm drain systems or receiving waters • tributary areas and drainage patterns across the project area (show using flow arrows) into each onsite stormwater inlet or receiving water • tributary areas and drainage patterns to each onsite stormwater inlet, receiving water or discharge point • offsite tributary drainage areas that generate run-on to the project City of Carlsbad WPCP Template 5/6/2016 1/31/2018 Pollution Sources and Control Measures Page 30-10 l • ~mporary onsite drainage(s) to carry concentrated flows Water Pollution Control Program (WPCP) Palomar Airport Road Widening • lrainage patterns and slopes anticipated after major grading activities are completed • outline of all areas of existing vegetation, soil cover, or native vegetation that will remain undisturbed during the project • outline of all areas of planned soil disturbance ( disturbed soil areas, DSAs) • known location(s) of contaminated or hazardous soils • any potential non-stormwater discharges and activities, such as dewatering operations, concrete saw-cutting or coring, pressure washing, waterline flushing, diversions, cofferdams, and vehicle and equipment cleaning. If operations can't be located on the WPCDs, a narrative description is provided. The WPCDs show proposed locations of all construction site BMPs. Additional detail drawings are provided if necessary to convey site-specific BMP configurations. The WPCDs shall show construction site BMPs including the following: • temporary soil stabilization and temporary sediment control BMPs that will be used during construction. Any temporary onsite drainage(s) to carry concentrated flows, BMPs implemented to divert offsite drainage around or through the construction site, and BMPs that protect stormwater inlets • construction entrances used for site ingress and egress entrance and exit points and any proposed temporary construction roads • BMPs to mitigate or eliminate non-stormwater discharges • BMPs for waste management and materials pollution control, including, but not limited to storage of soil or waste; construction material loading, unloading, storage and access areas; and areas designated for waste handling and disposal • BMPs for vehicle and equipment storage, fueling, maintenance, and cleaning The WPCDs are included as Attachment A to this WPCP. 30.5 Water Pollution Control Schedule The Water Pollution Control Schedule (WPCS) is the component of the project WPCP that shows the timeline for when BMPs will be installed so that the project is in compliance with water pollution control requirements. The WPCS provides field staff with the information necessary to plan for adequate materials and crews to install BMPs at the right time so that they are effective. The Water Pollution Control Schedule and Water Pollution Control Drawings provide the necessary tools for a contractor to plan and implement BMPs to meet the requirements of the project WPCP. The WPCS shall contain an adequate level of detail to show major activities sequenced with implementation of construction site BMPs, including: • project start and finish dates, including each stage of the project • WPCP review and acceptance • mobilization dates City of Carlsbad WPCP Template 5/6/2016 1/31/2018 Pollution Sources and Control Measures Page 30-11 • mass clearing and grubbing/roadside clearing dates • major grading/excavation dates Water Pollution Control Program (WPCP) Palomar Airport Road Widening • dates named in other permits such as Fish and Game and Army Corps of Engineers Permits The WPCS shall show implementation dates by location for deployment of: • temporary soil stabilization BMPs • temporary sediment control BMPs • wind erosion control BMPs • tracking control BMPs • non-stormwater BMPs • waste management and materials pollution control BMPs The WPCS shall include: • paving, saw-cutting, and any other pavement related operations • major planned stockpiling operations • dates for other significant long-term operations or activities that may cause non-stormwater discharges such as dewatering, grinding, etc. • final stabilization activities for each disturbed soil area of the project The WPCS when updated shall be filed in WPCP File Category 20.03 Water Pollution Control Schedule Updates. The WPCS is included as Attachment B to this WPCP. City of Carlsbad WPCP Template 5/6/2016 1/31/2018 Pollution Sources and Control Measures Page 30-12 f Water Pollution Control Program (WPCP) Palomar Airport Road Widening SECTION 40 WPCP Implementation 40 .1 Water Pollution Control Manager Responsibilities The Water Pollution Control Manger (WPC Manager) shall have primary responsibility and authority to implement the WPCP. The WPC Manager is reponsible for WPCP implementation and amending the WPCP when any of the conditions specified in Section 10 are met. The Contractor has assigned authority to the WPC Manager to mobilize crews and subcontractors as necessary for WPCP compliance. The WPC Manager will be available at all times throughout duration of the project. Duties of the contractor's WPC Manager include but are not limited to: • ensuring compliance with the WPCP • implementing all elements of the WPCP and contract specifications , including but not limited to implementing: o prompt and effective erosion and sediment control measures 0 non-stormwater management, and materials and waste management activities such as: monitoring discharges (dewatering, diversion devices); general site clean-up; vehicle and equipment cleaning, fueling and maintenance; spill control; ensuring that no materials other than stormwater are discharged in quantities, which will have an adverse effect on receiving waters or storm drain systems, etc. • overseeing and ensuring that the following site inspections and visual monitoring is conducted: o daily required BMP inspections o weekly routine stormwater site BMP inspections 0 quarterly non-stormwater site inspections o pre-storm inspections for forecasted storm events o daily inspections during forecasted storm events o post-storm inspections for qualified rain events that produce project site runoff • monitoring NWS Forecast Office forecasts for both storm events and qualified rain events; these events are defined as follows: 0 a forecasted storm event is defined as a 50% or greater likelihood that 0.10 inches or more of precipitation will fall within a 24-hour period o a qualifying rain event is defined as a rain event that may produce or has produced ½ inch or more of precipitation • preparing Amendments to the WPCP when required • ensuring elimination of all unauthorized discharges • mobilizing crews in order to make immediate repairs to the control measures City of Carlsbad WPCP Template 5/6/2016 1/31/2018 WPCP Implementation Page 40-1 Water Pollution Control Program (WPCP) Palomar Airport Road Widening • coordinating with the Resident Engineer to assure all of the necessary corrections/repairs are made immediately, and that the project complies with the WPCP and approved plans at all times • preparing and submitting Notices of Discharge Reports • preparing and submitting Illicit Connections or Illegal Discharge Reports 40.2 Weather Forecast Monitoring The Water Pollution Control Manger (WPC Manager) shall have primary responsibility to monitor the National Weather Service Forecast Office for forecasted precipitation based on project site location. Precipitation forecast information shall be obtained from the National Weather service Forecast Office available at: http://www.srh.noaa.gov/ The project site location to be used for obtaining forecast from National Weather Forecast Office website is 33.122° N 117.319° w The WPC Manager shall monitor the weather forecast on a daily basis for predicted precipitation within the following 96 hours. The WPC Manager shall monitor the forecast for the next 24, 48, 72 and 96 hours to determine if the forecast for precipitation is 50 percent or greater for any 6-hour period. If the forecast for precipitation is 50 percent or greater, the WPC Manager shall calculate the amount of precipitation forecasted for each 24-hour period and the total precipitation for the forecasted storm event and record the information. When there is a forecasted fifty percent (50%) or greater chance of likely precipitation of 0.10 inch" or more then a pre- storm stormwater site inspection is required and the WPC Manager shall ensure that the site is prepared for the forecasted storm event. Site preparation for a forecasted storm event shall include, but is not limited to, the installation of soil stabilization and sediment best management practices on active disturbed soil areas and stockpiles. 40.3 Documentation of weather forecast monitoring shall be recorded on CEM-2040 Weather Forecast Monitoring Log form, in Appendix E. The weather monitoring logs shall be filed in WPCP File Category 20.40: Weather Monitoring Logs. Best Management Practices Status Report The Water Pollution Control Manger (WPC Manager) shall prepare a weekly status report of the water pollution control best management practies installed on the project site and best management practices that will be deployed the following week. Because the WPCP and WPCDs are based on the entire project site and all construction activities, the weekly BMP status report should be a "snapshot" of what best management practices could be expected to be seen on the project site that week. The weekly status report will be used by stormwater inspectors and contractor pesonnel to ensure WPCP compliance. The weekly status report will be used to ensure that weekly training meetings cover BMPs that are required for work activities during the week. The weekly status report will be provided to regulatory agency staff who visit the project site to indicate which BMPs should be in place and which are schedueled to be implemented during the week. The weekly status of stormwater BMPs will be documented on CEM-2034 Stormwater Best Management Practices Status Report form, in Appendix F. Completed weekly status reports shall be submitted to the RE 48 hours prior to the beginning of the work week. Copies of the completed reports will be kept in WPCP File Category 20.34: Best Management Practices Weekly Status Reports .. 40.4 Stormwater Site Inspections and Site Visual Monitoring City of Carlsbad WPCP Template 5/6/2016 1/31/2018 WPCP Implementation Page 40-2 l Water Pollution Control Program (WPCP) Palomar Airport Road Widening Stormwater site inspections and visual monitoring are necessary to ensure that the project is in compliance with WPCP. 40.5 Stormwater Site Ins pections Project site inspections of stormwater BMPs are conducted to identify and record: • that BMPs are properly installed • what BMPs need maintenance to operate effectively • what BMPs have failed • what BMPs could fail to operate as intended Routine stormwater site inspections shall be conducted by the Contractor's WPC Manager or other 24-hour trained staff at the following minimum frequencies: • daily for required BMPs • weekly • daily for projects within the Lake Tahoe Hydrologic Unit. Stormwater site inspections will be documented on CEM-2030 Stormwater Site Inspection Report in Appendix G. Completed inspection reports shall be submitted to the RE within 24 hours of inspection. Copies of the completed reports will be kept in WPCP File Category 20.31: Contractor Stormwater Site Inspection Reports. Deficiencies identified in site inspection reports and correction of deficiencies will be tracked on CEM-2035 Stormwater Site Inspection Report Corrective Actions Summary ,in Appendix H. Corrections summaries shall be submitted to the RE when corrections are completed but must be submitted within 5 days of a site inspection. Copies of the completed correction summary reports shall be attached to the corresponding Stormwater Site Inspection Report and shall be kept in WPCP File Category 20.31 : Contractor Stormwater Site Inspection Reports. 40 .6 Site Vis ual Monito ring Stormwater site visual monitoring inspections shall be conducted at the following minimum frequencies: • Prior to a forecasted storm event • At 24-hour intervals during extended forecasted storm events • Post qualifying rain event that generated site runoff • Quarterly for non-stormwater discharges Site visual monitoring inspections for non-stormwater discharges will be conducted once during each of the following periods: January-March, April-June, July-September, and October-December. If visual monitoring of the site is unsafe because of dangerous weather conditions, such as flooding and electrical storms, the stormwater site inspector shall document the reason for the exception. Documentation that the site visual monitoring inspection could not be performed shall be filed in WPCP File Category 20.33: Site Visual Monitoring Inspection Reports. City of Carlsbad WPCP Template 5/6/2016 1/31 /2018 WPCP Implementation Page 40-3 I l Water Pollution Control Program (WPCP) Palomar Airport Road Widening 40.6.1 Visual Monitoring Prior To a Forecasted Storm Event Visual monitoring of the project site is required when the forecast for precipitation is greater than 50 percent within the next 24, 48, 72, or 96 hours and the amount of precipitation forecasted for any 24-hour period during the forecasted storm event is O .10 inch or greater. Site visual monitoring for precipitation events shall be conducted within 48 hours prior to a forecasted storm event. The pre-storm site visual monitoring inspection shall visual observe: • all storrnwater drainage areas to identify any spills, leaks, or uncontrolled pollutant sources • any stormwater storage and containment areas to detect leaks and ensure maintenance of adequate freeboard • all BMPs for proper installation and adequate maintenance Observations of the site and any recommended corrective actions will be documented on CEM-2030 Stormwater Site Inspection Report. Any photographs used to document observations will be referenced on stormwater site inspection report. 40.6.2 Visual Monitoring During Extended Forecasted Storm Event Stormwater visual monitoring site inspections shall be conducted at least once each 24-hour period during extended forecasted storm events The during storm site visual monitoring inspection shall visual observe: • stormwater discharges at all discharge locations • any stored or contained stormwater that is derived from and discharged subsequent to the forecasted storm event. Stored or contained stormwater that will likely discharge after working hours due to anticipated precipitation shall be observed prior to the discharge during working hours. Stormwater discharges and stored or contained stormwater will be observed for the presence or absence of floating and suspended materials, sheen on the surface, discolorations, turbidity, odors, and source(s) of any observed pollutants. A during forecasted storm event visual monitoring site inspection will include observation of all site BMPs for: • proper installation • maintenance • failure • BMPs that could fail to operate as intended • effectiveness so that design changes can be implemented as soon as feasible Observations of the site and any recommended corrective actions will be documented on CEM-2030 Stormwater Site Inspection Report. Any photographs used to document observations will be referenced on stormwater site inspection report. Required corrective actions will be initiated within 72 hours after they are identified and completed as soon as possible. 40.6.3 ~isual Monitoring Within 48 Hours After A Qualifying Rain Event Generating Site Runoff Site visual monitoring post precipitation events shall be conducted within 48 hours of any qualifying rain event that causes site runoff. The post-storm site visual monitoring inspection shall visual observe: City of Carlsbad WPCP Template 5/6/2016 1/31/2018 WPCP Implementation Page 40-4 { l I • Stormwater discharges at all discharge locations Water Pollution Control Program (WPCP) Palomar Airport Road Widening • Any stored or contained stormwater that is derived from and discharged subsequent to the qualifying rain event. Stored or contained stormwater that will likely discharge after working hours due to anticipated precipitation shall be observed prior to the discharge during working hours. Stormwater discharges and stored or contained stormwater will be observed for the presence or absence of floating and suspended materials, sheen on the surface, discolorations, turbidity, odors, and source(s) of any observed pollutants. Post qualifying rain event stormwater visual monitoring site inspection will include observation of all site BMPs for: • proper installation • maintenance • failure • BMPs that could fail to operate as intended • effectiveness so that design changes can be implemented as soon as feasible Observations of the site and any recommended corrective actions will be documented on fCEM-2030 Stormwater Site Inspection Report. Any photographs used to document observations will be referenced on stormwater site inspection report. Any corrective actions will be completed as soon as possible but ifBMPs require design changes the implementation of changes will begin within 72 hours of identification and the changes will be completed as soon as possible. 40.6.4 Visual Monitoring Non-Stormwater Discharges Visual monitoring and observations for non-stormwater discharges will be conducted for the presence or indications of prior unauthorized and authorized non-stormwater discharges and their sources. The presence or absence of non- stormwater discharges based on site observations will be documented on CEM-2030 Stormwater Site Inspection Report. Documentation of observed non-stormwater discharges will include presence or absence of floating and suspended materials, sheen on the surface, discolorations, turbidity, odors, and source(s) of any observed pollutants. Observations of the site and the response taken to eliminate any unauthorized non-stormwater discharges and to reduce or prevent pollutants from contacting non-stormwater discharges shall be documented on CEM-2030 Stormwater Site Inspection Report. Any photographs used to document observations will be referenced on stormwater site inspection report. If a discharge or evidence of a prior discharge is discovered, reporting will comply with the requirements in Section 50- 2 Discharge Reporting Requirements. If an illicit connection or illegal discharge is discovered, reporting will comply with the requirements in Section 50-4 Illicit Connection/Illegal Discharge Reporting. 40.6.5 Visual Monitoring Documentation, Follow-up and Tracking Procedures Site visual monitoring site inspections will be documented on CEM-2030 Stormwater Site Inspection Report, in Appendix G. Completed inspection reports shall be submitted to the Resident Engineer within 24 hours of inspection. Copies of the completed reports will be kept in WPCP File Category 20.33: Site Visual Monitoring ,Inspection Reports. City of Carlsbad WPCP Template 5/6/2016 1/31/2018 WPCP Implementation Page 40-5 f ( Water Pollution Control Program (WPCP) Palomar Airport Road Widening For deficiencies identified by site visual monitoring inspections the required repairs or maintenance ofBMPs shall begin and be completed as soon as possible. For deficiencies identified by visual site inspections that require design changes, including additional BMPs, the implementation of changes will begin within 72 hours of identification and be completed as soon as possible. When design changes to BMPs are required the WPCP shall be amended, including Water Pollution Control Drawings. Deficiencies identified in site visual monitoring inspection reports and correction of deficiencies will be tracked on CEM-2035 Stormwater Site Inspection Report Corrective Actions Summary, in Appendix H. Corrections summaries shall be submitted to the RE when corrections are completed and must be submitted within 5 days of the site inspection. Completed CEM-2035 Stormwater Site Inspection Report Corrective Actions Summary forms shall be filed in WPCP File Category 20.35: Corrective Actions Summary. A copy of the completed CEM-2035 Stormwater Site Inspection Report Corrective Actions Summary form will also be attached to the corresponding visual monitoring inspection report and shall be kept in the WPCP File Category 20.33. City of Carlsbad WPCP Template 5/6/2016 1/31/2018 WPCP Implementation Page 40-6 f { l f SECTION 50 WPCP Reporting Requirements 50.1 Record Keeping Water Pollution Control Program (WPCP) Palomar Airport Road Widening To manage the various documents required to by the WPCP and to provide easy access to the documents the following WPCP file categories will be used to file WPCP compliance documents: • File Category 20.01 Water Pollution Control Program (WPCP) • File Category 20.03 Water Pollution Control Schedule Updates • File Category 20.10 Correspondence • File Category 20.23 Stormwater Training Documentation • File Category 20.31 Contractor Stormwater Site Inspection Reports • File Category 20.33 Site Visual Monitoring Inspection Reports • File Category 20.34 Best Management Practices Weekly Status Report • File Category 20.40 Weather Monitoring Logs • File Category 20.61 Notice of Discharge Reports Records shall be retained for a minimum of three years for the following items: • Accepted WPCP and Amendments • Stormwater Site Inspection Reports • Site Inspection Report CorrectiveActions Summary • Notice of Discharge Reports 50.2 Discharge Reporting If a discharge or evidence of a prior discharge is discovered by the contractor, the contractor shall notify the Resident Engineer within 6 hours of the discharge event or discovery, and will file a written report to the Resident Engineer within 48 hours of the discharge event or discovery of evidence of a prior discharge. The written report to the Resident Engineer will contain the following items: • the date, time, location, and type of unauthorized discharge • nature of operation that caused the discharge • initial assessment of any impacts caused by the discharge • the BMPs deployed before the discharge event • the date of deployment and type ofBMPs deployed after the discharge event, including additional measures installed or planned to reduce or prevent re-occurrence City of Carlsbad WPCP Template 5/6/2016 1/31/2018 WPCP Reporting Requirements Page 50-1 { { { ( [ { r { Water Pollution Control Program (WPCP) Palomar Airport Road Widening • steps taken or planned to reduce, eliminate and/or prevent recurrence of the discharge Reporting of discharges shall be documented on CEM-2061 Notice of Discharge Report, in Appendix I. Completed CEM-2061 Notice of Discharge Report shall be submitted to the Resident Engineer within 24 hours of discharge event or discovery of evidence of a prior discharge. Copies of the CEM-2061 Notice of Discharge Report will be kept in WPCP File Category 20.61: Notice of Discharge Reports. 50.3 Regulatory Agency Notice or Order Reporting If the project receives a written notice or order from any regulatory agency, the contractor will notify the Resident Engineer within 6 hours or receiving the notice or order and will file a written report to the Resident Engineer within 48 hours of receiving the notice, or order. Corrective measures will be implemented immediately following the notice or order. The report to the Resident Engineer will contain the following items: • date, time, location, and cause or nature of the notice or order • BMPs deployed prior to receiving notice or order • date of deployment and type ofBMPs deployed after receiving the notice or order, including additional BMPs installed or planned to reduce or prevent re-occurrence • an implementation and maintenance schedule for any affected BMPs 50.4 Illicit Connection/Illegal Discharge Reporting If the contractor discovers an illicit connection to a storm drain system or any pipe discharging on to the project site not shown on the project plans the contractor shall notify the Engineer within 6 hours of the discovery and will file a written report to the Engineer within 48 hours of the discovery. If the contractor discovers any illegal discharge including illegal dumping of material on the project site the contractor shall immediately notify the Engineer and will file a written report to the Engineer within 3 days of discovery. The report to the Engineer will contain the following items: • date, time, and location of the discovery • details of the illicit connection or illegal discharge, including any photographs taken • any actions taken to contain illegal discharge • any sampling and testing to determine material dumped or discharged City of Carlsbad WPCP Template 5/6/2016 1/31/2018 WPCP Reporting Requirements Page 50-2 ( r ( ( r ( I l ( l I l l Attachment A Water Pollution Control Drawings r ( l r l ( f ( l l EROSION CONTROL NOTES 1. THE EROSION CONTROL SYSTEMS REQUIRE CERTIFICATION BY THE ENGINEER OF RECORD. SUCH CERTIFIED SYSTEMS SHALL BE COMPLETED, INSPECTED, Mil lN PLACE ND LATER THAN OCTOBER 15TH. ALL ERDSlDN CONTROL SYSTEMS SHALL REMAIN IN PLACE AT ALL TI MES FOR ALL AREAS IN WHICH CONSTRUCT! ON IS NOT SCHEDULED TO COMMENCE WITHIN THE NEXT SEVEN (7) DAYS. ALL EROSION CONTROL SYSTEMS SHALL REMAIN IN PLACE l-NTIL APRIL 15TH. 2. THE CONTRACTOR, PERMITTEE OR OWNER SHALL BE RESPONSIBLE FOR THE INSPECTION, MOCIFICATION AND PROPER MAINTENANCE OF THE EROSION CONTROL DEV ICES AS NECESSARY. IN THE EVENT OF FA I LURE OR REFUSAL TO PROPERLY MAINTAIN SAID DEVICES, THE CITY ENGINEER MAY CAUSE EMERGENCY MA I NTENANCE WORK TO BE DONE TO PROTECT ADJACENT PRIVATE AND PUBLIC PROPERTY, THE COST ( INCLlOING AN INITIAL l,IQBJLIZATION AMOUNT) OF WHICH SHALL BE CHARGED TO THE OWNER. 3. ALL EROSION CONTROL MEASURES REQUIRED TO RETAIN SEDIMENT ON-SITE AND TO SAFELY DISCHARGE ANY ACCELERATED RUNOFF GENERATED BY THE PROv£CT SHALL BE INSTALLED DURING THE INITIAL CONSTRUCTION PHASE OF THE PROJECT. 4. THE CONSTRUCTION AND MAINTENANCE OF ALL EROSION CONTROL SYSTEMS SHALL BE IN SUBSTANTIAL CONFORMANCE WITH THE APPROVED EROS I ON CONTROL PLAN. 5. TEMPORARY EROSION CONTROL DEVICES SHOWN ON THE EROSJDN CONTROL PLAN WHICH INTERFERE WITH THE WORK SHALL BE RELOCATED OR MODIFIED AS THE WORK PROGRESSES AS RECOMMENDED BY THE ENG I NEER OF WORK AND AS APPROVED BY THE CITY ENGINEER. 6. ALL REMOVABLE PROTECTION DEVICES SHOWN SHALL BE IN PLACE AT THE END OF EACH WORKING DAY WHEN THE 5-DAY RAIN PROBABILITY FORECAST EXCEEDS 40-PERCENT . 7. EROSION CONTROL SYSTEMS SHALL BE SERVICED AND MAINTAINED TO PROVIDE CONTINUOUS CAPACITY AND ADEQUACY TO FUNCTION AS DESIGNED. AFTER PRECIPITATION EXCEEDING ONE-QUARTER (1/4) INCH IN ANY 12-HOUR PERIOD, OR UPON DIRECTION OF THE CITY ENGINEER, SILT AND DEBRIS SHALL BE REMOVED FROM CHECK DAMS AND DESlLTlNG BASINS AND THE BASINS PUMPED DRY AND OTHERWISE RESTORED TO THE ORIGINAL DESIGN CONDITION. 8. DESILTING BASINS CONSTRUCTED OF COMPACTED EARTH SHALL BE CO!.f'ACTED TO A RELATIVE COMPACTION OF 90 PERCENT OF MAXIMUM DENSITY. A SOIL ENGINEERING REPORT INCLUDING THE TYPE OF FIELD TESTING PERFORMED, LOCATION, AND RESULTS OF TESTING SHALL BE SUBMITTED TO THE CITY ENGINEER FOR APPROVAL UPON COMPLETING THE DESILTING BASIN. 9. EROSION CONTROL PROVISIONS SHALL INCLUDE AND COMPLEMENT DRAINAGE PATTERNS DURING THE CURRENT AND FUTURE PHASES OF GRADING THROUGHOUT THE RAINY SEASON. 10. THE CONTRACTOR, PERMITTEE, OR PROJECT OWNER SHALL BE RESPONSIBLE AND SHALL TAKE NECESSARY PRECAUTIONS TO PREVENT PUBLIC TRESPASS ONTO AREAS WHERE IMPOUNDED WATER CREATES A HAZARDOUS CONDITION. NECESSARY PRECAUTIONS MAY INCLUDE, BUT NOT BE LIMITED TO, APPROPRIATE PERIMETER FENCING OR A 24-HOUR GUARD PREVENTING l-NAUTHORIZED PERSONS FROM ENTERING THE BASINS. 11. GRADED AREAS AROUND THE TRACT PERIMETER MUST DRAIN AWAY FROM THE FACE OF SLOPES AT THE CONCLUSION OF EACH WORK I NG DAY. 12. PAVED STREETS, SIDEWALKS, AND OTHER IMPROVEMENTS SHALL BE MAINTAINED IN A NEAT AND CLEAN CONDITION, FREE OF LOOSE SOIL, CONSTRUCTION DEBRIS, AND TRASH. STREET SWEEPING OR OTHER EQUALLY EFFECTIVE MEANS SHALL BE USED ON A REGULAR BASIS TO CONTROL EROSION. WATERING SHALL NOT BE USED TO CLEAN STRms EXCEPT FOR THE REMOVAL OF FINE MATERIAL NOT OTHERWISE REMOVED BY SWEEPING OR OTHER MECHANICAL MEANS. 13. STAi'IJ-BY CREWS SHALL BE ALERTED BY THE CONTRACTOR, PERM!TTEE OR OWNER FOR EMERGENCY WORK DUR I NG RAINSTORMS. 14. GRAVEL BAGS AND NECESSARY MATERIALS IN ACCORDANCE WITH THE APPROVED PLANS, SHALL BE AVAILABLE ON SITE AND STOCKPILED AT CONVENIENT LOCATIONS TO FACILITATE RAPID CONSTRUCTION OF TEMPORARY DEVICES OR TO REPAIR ANY DAMAGED EROSION CONTROL MEASURES WHEN RAIN IS IMMINENT. A STAND-BY CREW SHALL BE MADE AVAILABLE AT ALL TIMES DURING THE RAINY SEASON. 15. ALL UTILITY TRENCHES SHALL BE BACKFILLED WITHIN 24 HOURS AND MUST BE BACKFILLED BEFORE THE END OF THE WORK DAY IF A 4D-PERCENT CHANCE OF RAIN IS PREDICTED. 16. A GRAVEL BAG SILT BASIN OR TRAP SHALL BE PROVIDED AT EVERY STORM DRAIN INLET TO PREVENT SEDIMENT FROM ENTERING THE STORM DRAIN SYSTEM. 17. A 12-INCH HIGH BY 4-FODT WIDE BERM SHALL BE MAINTAINED ALONG THE TOP OF THE SLOPE OF THOSE FILLS ON WHICH GRADING IS NOT IN PROGRESS. CONCENTRATED WATER SHALL BE CARRIED NOT CLOSER THAN 10--FEET FROM THE TOP OF SLOPES. 18. ALL BUILDING PADS SHALL BE SLOPED TOWARDS THE DRIVEWAY AND VELOCITY CHECK DAMS PROVIDED AT THE BASE OF ALL DRIVEWAYS DRAINING INTO THE STREET. VELOCITY CHECK DAMS SHALL BE PROVIDED ACROSS THE OUTLETS OF ALL LOTS DRAINING INTO THE STREET. 19. PROVIDED VELOCITY CHECK DAMS IN ALL UNPAVED STREET AREAS AT THE INTERVALS INDICATED BELOW. VELOCITY CHECK DAMS MAY BE CONSTRUCTED OF GRAVEL BAGS, Til.flER, OR OTHER EROSION RESISTANT MATERIALS APPROVED BY THE CITY ENGINEER, AND SHALL EXTEND COMPLETELY ACROSS THE STREET AT R!GffT ANGLES TO THE CENTERLINE. EARTH DIKES MAY NDT BE USED AS VELOCITY CHECK DAMS. CHECK DAM INSTALLATION SHALL PROVIDE FOR THE PREVENTION OF EROSION AROl,ND THE Ei'IJS OF THE DAM. GRADE OF THE STREET LESS THAN 2% 2% TO 4% 4% TD 1D% OVER 10% INTERVAL AS REQUIRED 1DD FT 5D FT 25 FT 20. ALL EROSION CONTROL PLANS MUST PROVIDE A 24-HOUR TELEPHONE tu.4BER Ai'IJ THE NAME(S) OF THE PERSON(S) RESPONSIBLE FOR EMERGENCY WORK. A TELEPHONE ANSWERING MACHINE OR ANSWERING SERVICE IS UNACCEPTABLE. CONTACT ________ _ NAME AREA CODE NUMBER WATER POLLUTION CONTROL DRAWINGS PALOMAR AIRPORT ROAD WIDENING SHEET INDEX TITLE SHEET EROS I ON COIHROL PLAN LEGEND .l.IEM G)--INST ALL SILT FENCE ALONG PROJECT PERIMETER PER DETAIL 1 THIS SHEET PALOMAR AIRPORT RD AT PASEO DEL NORTE CITY OF CARLSBAD, SAN DIEGO COUNTY, CALIFORNIA LEGAL DESCRIPTION -AREA OF IMPROVEMENT AREA OF IMPROVEMENT KEY MAP SCALE 1 "=40' 1 BASIS OF BEARING RIGffT-OF-WAY OF PALOMAR AIRPORT ROAD Ai'IJ INTERSTATE HWY 5 THE BASIS OF COORDINATES AND BEARINGS FOR THIS EXHIBIT IS THE CALIFORNIA COORDINATE SYSTEM OF 1983 (EPOCH 1991. 35), ZONE 6, BASED LOCALLY UPON THE FOLLOWING HORIZONTAL CONTROL STATIONS AS SHOWN ON RECORD OF SURVEY NO. 17350. OWNER/DEVELOPER BENCHMARK CITY OF CARLSBAD 1635 FARADAY AVE. CARLSBAD, CA 92D0B CITY OF CARLSBAD SURVEY CONTROL NETWORK "CLSB-057". A 2.5" DISK IN DRAINAGE BOX INLET ON THE SOUTHWEST QUADRANT OF AVENIDA ENCINAS AND CANNON ROAD. ELEVATION= 44.D10' DATUM: NGVD29 DECLARATION OF ENGINEER OF WORK I HEREBY DECLARE THAT THE DESIGN OF THE IMPROVEMENTS AS SHOWN ON THESE PLANS COMPLIES ~TH PROFESSIONAL ENGINEERING STANDARDS AND PRACTICES. AS THE ENGINEER IN RESPONSIBLE CHARGE OF THE DESIGN OF THESE IMPROVEMENTS, I ASSUME FULL RESPONSIBLE CHARGE FOR SUCH DESIGN. I UNDERSTAND AND ACKNO\\\.EDGE THAT THE PLAN CHECK OF THESE PLANS BY THE CITY OF OCEANSIDE IS A REVIEW FOR THIS LIMITED PURPOSE OF ENSURING THE PLANS COMPLY ~TH CITY PROCEDURES AND OTHER APPLICABLE POLICIES AND ORDINANCES. THE PLAN CHECK IS NOT A DETERMINA TlON OF THE TECHNICAL ADEQUACY OF THE DESIGN OF THE IMPROVEMENTS. SUCH PLAN CHECK DOES NOT, THEREFORE, REUEVE ME OF MY RESPONSIBILITY FOR THE DESIGN OF THESE IMPROVEMENTS. AS ENGINEER OF WORK, I AGREE TO INDEMNIFY AND SA VE THE CITY OF OCEANSIDE, ITS OFFICERS, AGENTS AND EMPLOYEES HARMLESS FROM ANY ANO ALL LIABILITY, CLAIMS, DAMAGES OR INJURIES TO ANY PERSON OR PROPERTY WHICH MIGHT ARISE FROM THE NEGLIGENT ACTS, ERRORS OR OMISSIONS OF THE ENGINEER OF WORK, MY EMPLOYEES, AGENTS OR CONSULTANTS. DAVID A. WIENER Michael Baker INTERNATIONAL \ \ 5050 Avenida Endnas Suite260 Carlsbad, CA 92008 Phone: (760)476-9193 MBAKER/Nn.COM 1. SET POSTS AND EXCAVATE A 4 BY 4 IN ( 10 BY 10 CM) TRENCH UPSLOPE FROM AND ALONG THE LI NE OF POSTS. 3. ATTACH THE FILTER FABRIC TO THE WIRE FENCE AND EXTEND IT INTO THE TRENCH. 2. STAPLE WIRE FENCING TO THE POSTS. 4 IN (10 CM) ®-I NS TALL GRAVEL BAG VELOC !TY CHECK DAMS, TWO BAGS HIGH -ONE BAG WIDE PER DETAIL 2 THIS SHEET @---INST ALL GRAVEL BAG AROUND CURB INLET PER DETAIL 3 THIS SHEET DOUBLE ROW OF AVEL BAGS 4 . BAC'~F I LL Ar-v COMPACT THE EXCAVATED SOIL. PROFILE DIRECTION OF FLOW (OMIT ONE( 1 )BAG ON TOP ROW FOR INFLOW CD SILT FENCE DETAIL NOT TO SCALE G) TYPICAL CURB INLET DETAIL NOT TO SCALE PROJECT SITE VICINITY MAP NOT TO SCALE FACE OF CURB LIP OF GUTTER L # ) # ,,() DIRECTION OF ,L ,05• ff STREET FLOW I <;;:;; OF CURB I 50' INTERVALS TYPICAL STREET PLAN _[_2 BAG MIN~GRAVEL BAGS (TYP) _a_~ - TYPICAL I SECTION TYPICAL ELEVATION 0') GRAVEL BAG PLACEMENT DETAIL \,!;_,I NOT TO SCALE "AS DIRECTION OF FLOW BUILT" RC[___ EXP.____ DATE REVIEWED BY: INSPECTOR I SH1EET I CITY OF CARLSBAD 1---,-,--+-----------------+--+---,r---t---l PUBLIC 1,/0RKS DEPARTMENT >---,f---+-----------------+--+---,f----+--.. >---,f---+-----------------+--+---,r----+--_, EROSION CONTROL PLAN FOR: PALOMAR AIRPORT ROAD WIDENING AT PASEO DEL NORTE DATE [sHEffil L.QU ACCEPTED PAT A. THOMAS 1---,r---+-----------------+--+---,r---t---l ::;P~UB:';:l~IC:;;WO;;=R::KS::::::::DIR::E:::CT::::O~R========:;;::=:::D::::ATE:::::::~ 1-~0,~TEc,--,"l"Ni"'TIAL.,,--,---------------+ 1 ...,0,,.,=rrc-!-c1NcclTI:cAc-L-+-c:-0cc,rr=-+:-,N"rn"'AL,-t OWN BY:___ PROJECT NO. I DRA~NG NO. ENGlNEER DF \IURK REVISION DESCRIPTION l'-O-lll_E_R_AP~P-RO_V_Al-+-c,-lY-APLP-RO_V_AL-1 2~ ~~; ===== 6044 . 496-9 z 0 0: w ~ u f-' 0: < I l [ r f l l [ ' ' ""----- AC PAVING ~-f--- BASIS OF BEARING THE BASIS OF COORDINATES AND BEARINGS FOR THIS EXHIBIT IS THE CALIFORNIA COORDINATE SYSTEM Of 1983 ( EPOCH 1991 . 35) , ZOl>E 6 , BASED LOCALLY UPON THE FOLLOWING HORIZONTAL CONTROL STATIONS AS SH'.JWN ON RECORD OF SURVEY NO. 17350. AC PAVING BENCHMARK CITY OF CARLSBAD SURVEY CONTROL NETWORK "CLSB-057". A 2.5" DISK IN DRAINAGE BOX INLET ON THE SOUTHWEST QUADRANT Of AVEN !DA ENCINAS Al>O CANNON ROAD. ELEVATION= 44.010' DATUM: NGVD29 1 I I ~ LEGEND l.lli! (D--INST ALL SILT FENCE ALONG PROJECT PERH.ETER PER DETAIL 1 ON SHEET 1 @--INSTALL GRAVEL BAG VELOCITY CHECK DAMS, TWO BAGS HIGH -Ot-E BAG WIDE PER DETAIL 2 ON SHEET 1 @-INST ALL GRAVEL BAG AROUND CURB It-LET PER DETAIL 3 ON SHEET 1 -----------------------_, ____ , I ' ~ ~PALOMAR AIRPORT-ROAD ---' I ~' --AC GRIND & OVERLAY Michael Baker 5050 Avenida Encinas Suite260 Carlsbad, CA 92008 Phone: (760) 476-9193 I N T E R N AT I O N A L MBAKERl/fll.COM --------50' - 20 10 0 20 40 60 I ~71 I I I SCALE: 1 "=20' _J "AS BUILT" RCE ___ EXP.___ DATE REVIEWED BY: INSPECTOR DA TE I SH2EET I CITY OF CARLSBAD ~2 1-----+---+--------------+---+--+--+----l PUBLIC l<DRKS DEPARTMENT l_QU 1-----+---+--------------+---+--+--+----l 1-----+---+--------------+---+--+--+----l EROSION CONTROL PLAN FOR: PALOMAR AIRPORT ROAD WIDENING AT PASEO DEL NORTE t---+---+--------------+---+-----+--+----1 ACCEPTED PAT A. THOMAS 1-----+---+--------------+---+--+--+----l ~P~UB~UC':;;WO~RK:::S::::D:::IRE::CT:::;OR~=~~::::::::::::::::::=~~D::::A:::':TE==;:: OWN BY: I PROJECT NO. I DRAWING NO. DATE INITIAL DAlE INlllAL CHKD BY - f--0"-TH--ERc....AP..LP--RO-VAL--'-lf--"-CI--TY'--AP-'-P-"-RO--V'-"AL-I RVWD BY; -__ ~044 496-9 DATE INITIAL ENGINEER OF WORK REVISION DESCRIPTION z 0 "' w ::, < u ..., "' < I f l I I . l I I ( l Attachment B Water Pollution Control Schedule r r r Contractor to Insert Water Pollution Control Schedule. l Attachment C WPCP Amendments STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION SWPPP/WPCP AMENDMENTS LOG CEM-2009 (NEW 5/2011) PROJECT INFORMATION NAME AND SITE ADDRESS CONTRACTOR NAME AND ADDRESS CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDID NUMBER PROJECT SITE WATER POLLUTION CONTROL □WPCP □ SWPPP Amendments Log Amendment Date Brief Description Number of Amendment Page 1 of 1 SWPPP PROJECT SITE RISK LEVEL □ Risk Level 1 □ Risk Level 2 □ Risk Level 3 Requested by Approval Date ADA For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-641 O Notice or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION SWPPP/WPCP AMENDMENTS LOG CEM-2009 (NEW 5/2011) Instructions GENERAL INFORMATION • Projects with either a Stormwater Pollution Prevention Plan (SWPPP) or Water Pollution Control Program (WPCP) require the information on this form to document amendments. • Attach a completed copy of the form to each approved SWPPP/WPCP amendment, and include in SWPPP Attachment DD or WPCP Attachment C. FORM Contract Number/Co/Rte/PM For local agency encroachment permit projects, write the encroachment permit number in the Contract Number field. Project Identifier Number Caltrans projects starting July 1, 2010, will have a project identifier 'number. For projects without one, write "N/A" in the field. WDID Number For projects with WCPC enter "WPCP' in this field. When the resident engineer has approved SWPPP or WPCP amendments, enter: 1. The amendment number. 2. The date. 3. A brief description of the amendment. 4. The name and title of person who requested the amendment. 5. The dale the resident engineer approved it. I l I J I Attachment D Stormwater Training Documentation ( ( I J I I I I I Appendix A CEM-2008 SWPPP/WPCP Amendment Certification and Acceptance STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION SWPPP/WPCP AMENDMENT CERTIFICATION AND ACCEPTANCE CEM-2008 (REV. 12/2011) PROJECT INFORMATION NAME AND SITE ADDRESS CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDID NUMBER CONTRACTOR NAME AND ADDRESS PROJECT SITE RISK LEVEL Page 1 of 3 □ □ □ Risk Level 1 Risk Level 2 Risk Level 3 □ N/A. Project resides in the Lake Tahoe Hydrologic Unit and is reg- ulated under Order No. R6T-2011- 0019, NPDES No. CAG616002. Stormwater Pollution Prevention Plan (SWPPP)/Water Pollution Control Program (WPCP) Amendment Number CONTRACTOR WATER POLLUTION CONTROL MANAGER SIGNATURE DATE CONTRACTOR WATER POLLUTION CONTROL MANAGER NAME PHONE NUMBER Contractor Certification of SWPPP or WPCP Amendment I certify under penalty of law that this document and all attachments were prepared under my direction or supervision according to a system designed to ensure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system or persons directly responsible for gathering the information, the information submitted, to the best of my knowledge and belief, is true, accurate, and complete. I am aware that significant penalties exist for submitting false information, including the possibility of fine and imprisonment for knowing violations. CONTRACTOR SIGNATURE DATE CONTRACTOR NAME PHONE NUMBER TITLE Resident Engineer Acceptance and Approval of SWPPP or WPCP Amendment I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to ensure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system or those directly responsible for gathering the information, the information submitted, to the best of my knowledge and belief, is true, accurate, and complete. I am aware that significant penalties exist for submitting false information, including the possibility of fine and imprisonment for knowing violations. RESIDENT ENGINEER SIGNATURE DATE OF AMENDMENT APPROVAL AND ACCEPTANCE RESIDENT ENGINEER NAME PHONE NUMBER ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. l STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION SWPPP/WPCP AMENDMENT CERTIFICATION AND ACCEPTANCE CEM-2008 (REV. 12/2011) PROJECT INFORMATION NAME AND SITE ADDRESS CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDID NUMBER Stormwater Pollution Prevention Plan (SWPPP)/Water Pollution Control Program (WPCP) Amendment Number ------------ Required for Private Entity Administered Projects Page 2 of 3 I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to ensure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those directly responsible for gathering the information, the information submitted, to the best of my knowledge and belief is true, accurate, and complete. I am aware that significant penalties exist for submitting false information, including the possibility of fine and imprisonment for knowing violations. LEGALLY RESPONSIBLE PERSON SIGNATURE DATE LEGALLY RESPONSIBLE PERSON NAME TITLE PHONE NUMBER Required for Local Agency/Private Entity Administered Project Caltrans Oversight Engineer's Concurrence With SWPPP/WPCP Amendment I and personnel acting under my direction and supervision have reviewed this WPCP and find that it meets the requirements set forth in the contract Special Provisions, Caltrans Standard Specifications, section 7-1.01G, "Water Pollution and the Caltrans SWPPP/WPCP Preparation Manual." OVERSIGHT ENGINEER SIGNATURE DATE OF AMENDMENT CONCURRENCE OVERSIGHT ENGINEER NAME PHONE NUMBER ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION SWPPP/WPCP AMENDMENT CERTIFICATION AND ACCEPTANCE CEM-2008 (REV. 12/2011) Instructions GENERAL INFORMATION The information on CEM-2008 is required for projects with either a Stormwater Pollution Prevention Plan (SWPPP) or a Water Pollution Control Program (WPCP) to document amendment acceptance and/approval. SWPPP amendments must be approved by CEM-2006, "Legally Responsible Person Authorization of Approval Signatory," signed by the legally responsible person (LRP). 1. For Caltrans, the LRP is the district director. The LRP may authorize the project resident engineer to be approved signatory. Page 3 of 3 2. For a local agency, the LRP is either a principal executive officer or a ranking elected official. The local agency LRP may authorize the project resident engineer to be approved signatory. 3. For a private entity performing work in the state right-of-way under an encroachment permit, the LRP must be one of the following: a. For a corporation, a responsible corporate officer. b. For a partnership or sole proprietorship, a general partner or the proprietor, respectively. The private entity LRP may not authorize an approved signatory. 4. Attach a completed copy of CEM-2008 to each SWPPP or WPCP amendment, and include it in the SWPPP Attachment DD or the WPCP Attachment C. FORM Contract Number/Co/Rte/PM For local agency encroachment permit projects, write the encroachment permit number in the Contract Number field. Project Identifier Number Caltrans projects starting July 1, 2010, will have a Project Identifier Number. For projects without one, write "N/A" in the field. WDID Number For projects that have a Water Pollution Control Program enter "WPCP" in this field. Project Site Risk Level Check the box for the appropriate SWPPP risk level or N/A for projects in the Lake Tahoe Hydrologic Unit. ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. { { l I l { I t l Appendix B CEM-2009 SWPPP/WPCP Amendments Log r l STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION SWPPP/WPCP AMENDMENTS LOG CEM-2009 (REV. 12/2011) PROJECT INFORMATION NAME AND SITE ADDRESS Page 1 of 1 CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDID NUMBER CONTRACTOR NAME AND ADDRESS PROJECT SITE WATER POLLUTION SWPPP PROJECT SITE RISK LEVEL CONTROL □WPCP 0SWPPP Amendments Log D Risk Level 1 D Risk Level 2 D Risk Level 3 □ N/A. Project resides in the Lake Tahoe Hydrologic Unit and is reg- ulated under Order No. R6T-2011- 0019, NPDES No. CAG616002. Amendment Date Brief Description Requested by Approval Number of Amendment Date ADA For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-641 O Notice or TDD (916) 654-3880 or write Records and Forms Management, 11 20 N Street, MS-89, Sacramento, CA 95814. STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION SWPPP/WPCP AMENDMENTS LOG CEM-2009 (REV. 12/2011) Instructions GENERAL INFORMATION • Projects with either a Stormwater Pollution Prevention Plan (SWPPP) or Water Pollution Control Program (WPCP) require the information on this form to document amendments. • Attach a completed copy of the form to each approved SWPPP/WPCP amendment, and include in SWPPP Attachment DD or WPCP Attachment C. FORM Contract Number/Co/Rte/PM For local agency encroachment permit projects, write the encroachment permit number in the Contract Number field. Project Identifier Number Caltrans projects starting July 1, 2010, will have a project identifier number. For projects without one, write "N/A" in the field. WDID Number For projects with WPCP enter "WPCP" in this field. When the resident engineer has approved SWPPP or WPCP amendments, enter: 1. The amendment number. 2. The date. 3. A brief description of the amendment. 4. The name and title of person who requested the amendment. 5. The date the resident engineer approved it. ( r { ( l I { ( l ( t l ( l { { l Appendix C CEM-2023 Stormwater Training Record r I ( { l ( l STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION STORMWATER TRAINING RECORD CEM-2023 (REV. 12/2011) PROJECT INFORMATION NAME AND SITE ADDRESS CONTRACTOR NAME AND ADDRESS SUBMITTED BY CONTRACTOR (PRINT AND SIGN NAME) CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDID NUMBER PROJECT SITE RISK LEVEL □ Risk Level 1 □ Risk Level 2 □ Risk Level 3 □ □ Stormwater Training Record Training Course Title or Specific Training Objective Location Stormwater Topics Instructor Name D Temporary soil stabilization D Temporary sediment control D Tracking controls D Wind erosion control Instructor Title D Non-stormwater management D Stormwater discharge sampling D Waste management and materials pollution control D Spill prevention and control Phone D BMPs required for work activities current week D Stormwater pollution prevention plan Course Length (hours) D Water pollution control program Attendee Roster Name Company Page 1 of 3 N/A (WPCP) N/A. Project Resides in the Lake Tahoe Hydrologic Unit and is regulated under Order No. R6T-2011- 0019, NPDES No. CAG616002. Date of Training Type of Training D Formal D Informal Training Audience D General □BMPs □ SWPPP Phone ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. { ( l r ( l { STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION STORMWATER TRAINING RECORD CEM-2023 (REV. 12/2011) PROJECT INFORMATION NAME AND SITE ADDRESS CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDID NUMBER Attendee Roster Name Company Review and Record Keeping Has training information been entered into the Stormwater Training Log (CEM-2024}? Oves Page 2 of 3 Phone I have reviewed this document and, based on my inquiry of the person or persons who manage the system or those persons directly responsible for gathering the information, to the best of my knowledge and belief the information submitted is true, accurate, and complete. Water pollution control manager (name) Date Water pollution control manager signature STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION STORMWATER TRAINING RECORD CEM-2023 (REV. 12/2011) GENERAL INFORMATION Instructions • Projects with either a Stormwater Pollution Prevention Plan (SWPPP) or Water Pollution Control Program require the information on this form to document stormwater training for contractor and subcontractor managers, supervisors, and employees. Include the form and required training documentation in the stormwater annual report for SWPPP projects. Page 3 of 3 • Use this form to document training for employees responsible for activities associated with Construction General Permit compliance and contract specifications. Use this form to document required weekly informal stormwater training. • Provide this training record and an updated copy of CEM-2024, "Stormwater Training Log," to the resident engineer within five days of the date of training. • Attach additional copies of page 2 of this form if necessary to record all attendees attending training. FORM • Contract Number/Co/Rte/PM For local agency encroachment permit projects write the encroachment permit number in the Contract Number field. • Project Identifier Number Caltrans projects starting July 1, 2010, will have a Project Identifier Number. For projects without a PIO, write N/A in the field. • WDID Number For projects with Water Pollution Control Program, enter "WPCP." • Attendee Roster Enter employee name, contractor or subcontractor company name and employee phone number. • Training Audience Enter one of the following responses: General-Training for individuals responsible for activities associated with compliance with the Construction General Permit. BMPs-Training for individuals responsible for BMP installation, inspection, maintenance, and repair. SWPPP-Training for individuals responsible for overseeing revising and amending the SWPPP. r r f I l l Appendix D CEM-2024 Stormwater Training Log t- STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION STORMWATER TRAINING LOG CEM-2024 (REV. 12/2011) PROJECT INFORMATION NAME AND SITE ADDRESS CONTRACTOR NAME AND ADDRESS SUBMITTED BY CONTRACTOR (PRINT AND SIGN NAME) Page 1 of 2 CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDID NUMBER PROJECT SITE RISK LEVEL □ □ □ Risk Level 1 Risk Level 2 Risk Level 3 □ □ N/A(WPCP) N/A. Project resides in the Lake Tahoe Hydrologic Unit and is regulated under Order No. R6T-2011-0019, NPDES No. CAG616002. STORMWATER TRAINING LOG Number of Date Training Date of Training Training Stormwater Training Documentation Training Audience Course Title or Topics Covered Provided to Attendees Resident Engineer D General 0BMPs □ SWPPP 0 General 0BMPs □ SWPPP 0 General 0BMPs 0SWPPP O General 0BMPs □ SWPPP D General □BMPs □ SWPPP 0 General 0BMPs 0SWPPP 0 General 0BMPs □ SWPPP O General 0BMPs □ SWPPP 0 General 0BMPs 0SWPPP ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. r STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION STORMWATER TRAINING LOG CEM-2024 (REV. 12/2011) GENERAL INFORMATION Page 2 of 2 Instructions • For projects with either a Stormwater Pollution Prevention Plan or a Water Pollution Control Program the information shown on this form is required to document stormwater training for contractor and subcontractor managers, supervisors, and employees. The stormwater annual report for SWPPP projects will include required training documentation and the information on this form. • Provide an updated copy of CEM-2024 with attached training documentation to the resident engineer within five days of training. FORM Contract Number/Co/Rte/PM For local agency encroachment permit projects, write the encroachment permit number in the Contract Number field. Project Identifier Number Caltrans projects starting July 1, 2010, will have a Project Identifier Number. For projects without a PID, write N/A in the field. WDID Number For projects with Water Pollution Control Program enter "WPCP" in this field. Training Audience Check one of the following responses: General-training for individuals responsible for activities associated with compliance with the General Construction Permit. BMPs-training for individuals responsible for BMP installation, inspection, maintenance, and repair. SWPPP-training for individuals responsible for overseeing revising and amending the SWPPP. I r l I l I r Appendix E CEM-2041 Weather Forecast Monitoring Log STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION WEATHER MONITORING LOG CEM-2041 (NEW 5/2012) Page PROJECT INFORMATION NAME AND SITE ADDRESS CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDIDNUMBER CONTRACTOR NAME AND ADDRESS PROJECT SITE RISK LEVEL □ Risk Level 1 □ Risk Level 2 □ Risk Level 3 SUBMITTED BY CONTRACTOR (PRINT AND SIGN NAME) DATE Weather Condition Oc1ear □ Partly Cloudy □ Cloudy Storm event began? on (time) (date) Cumulative amount of precipitation from previous day? inches Storm event ended? WEEKLY REPORTING PERIOD Week of / / / / Weather Information for Temperature Precipitation Condition ONone □Misty Wind Condition ONone Maximum "F Minimum "F D Light rain ORain Storm Precipitation Information D Heavy rain □Hail Osnow D Less than 5 mph D Greater than 5 mph Complete the following when there is any precipitation within the 24-hour period. Storm Event Information Project Site Difference From Cumulative What is the cumulative amount of precipitation for storm Time Rain Gauge Previous Amount of event to date? Reading Precipitation Reading inches (inches) (inches) --- What is the 24-hour cumulative amount of precipitation? inches --- of 3 on Is the cumulative amount of precipitation for storm event 1/2 inch or greater? (time) {date) Oves □No If yes for risk level 2 and 3 projects are stormwater discharges being D Extended duration storm event sampled and analyzed? Oves □No Additional Storm Event Information Compliance Storm Event The compliance storm event (5-year, 24-hour Has the storm event exceeded the storm) for this project site is: compliance storm event? inches Oves ATS Compliance Storm Event Complete the following when ATS is used on project site The compliance storm event (10-year, 24-hour storm) for this project site is: inches Has the storm event exceeded the compliance storm event? Oves If yes to exceedance of the compliance storm event based on project site rain gauge readings, attach printout of precipitation data from nearest National Weather Service weather station as verification of compliance storm exceedance. Verification of project site compliance storm event exceedance from weather station __________ is based on project site address or latitude and longitude. ___________________ (NWS) Weather Station Weather information input by (print name and sign) STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION WEATHER MONITORING LOG CEM-2041 (NEW 5/2012) Weather Condition Oc1ear □ Partly Cloudy □ Cloudy Storm event began? on (time) (date) Cumulative amount of precipitation from previous day? inches --- Storm event ended? Page 2 Weather Information for Temperature Maximum OF Minimum OF Precipitation Condition 0None □Misty D Light rain 0Rain Storm Precipitation Information D Heavy rain □Hail Osnow Wind Condition 0None D Less than 5 mph D Greater than 5 mph Complete the following when there is any precipitation within the 24-hour period. Storm Event Information Project Site Difference From Cumulative What is the cumulative amount of precipitation for storm Time Rain Gauge Previous Amount of event to date? Reading Precipitation Reading inches (inches) (inches) --- What is the 24-hour cumulative amount of precipitation? inches --- of 3 on Is the cumulative amount of precipitation for storm event 1/2 inch or greater? (time) (date) Oves □No If yes for risk level 2 and 3 projects are stormwater discharges being D Extended duration storm event sampled and analyzed? Oves □No Additional Storm Event Information Compliance Storm Event The compliance storm event (5-year, 24-hour Has the storm event exceeded the storm) for this project site is: compliance storm event? inches Oves ATS Compliance Storm Event Complete the following when A TS is used on project site The compliance storm event (10-year, 24-hour storm) for this project site is: inches Has the storm event exceeded the compliance storm event? Oves If yes to exceedance of the compliance storm event based on project site rain gauge readings, attach printout of precipitation data from nearest National Weather Service weather station as verification of compliance storm exceedance. Verification of project site compliance storm event exceedance from weather station __________ is based on project site address or latitude and longitude. ____________________ (NWS) Weather Station Weather information input by (print name and sign) STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION WEATHER MONITORING LOG CEM-2041 (NEW 5/2012) Weather Condition Oc1ear □ Partly Cloudy □ Cloudy Storm event began? on (time) (date) Cumulative amount of precipitation from previous day? inches Storm event ended? Page 3 Weather Information for Temperature Maximum Minimum 'F 'F Precipitation Condition 0None □Misty D Light rain 0Rain Storm Precipitation Information D Heavy rain □Hail Osnow Wind Condition 0None D Less than 5 mph D Greater than 5 mph Complete the following when there is any precipitation within the 24-hour period. Storm Event Information Project Site Difference From Cumulative What is the cumulative amount of precipitation for storm Time Rain Gauge Previous Amount of event to date? Reading Precipitation Reading inches (inches) (inches) --- What is the 24-hour cumulative amount of precipitation? inches --- of 3 on Is the cumulative amount of precipitation for storm event 1/2 inch or greater? (time) (date) Oves □No If yes for risk level 2 and 3 projects are stormwater discharges being D Extended duration storm event sampled and analyzed? Oves □No Additional Storm Event Information Compliance Storm Event The compliance storm event (5-year, 24-hour Has the storm event exceeded the storm) for this project site is: compliance storm event? inches Oves ATS Compliance Storm Event Complete the following when A TS is used on project site The compliance storm event (10-year, 24-hour storm) for this project site is: inches Has the storm event exceeded the compliance storm event? Oves If yes to exceedance of the compliance storm event based on project site rain gauge readings, attach printout of precipItat1on data from nearest National Weather Service weather station as verification of compliance storm exceedance. Verification of project site compliance storm event exceedance from weather station __________ is based on project site address or latitude and longitude. ____________________ (NWS) Weather Station Weather information input by (print name and sign) WEATHER MONITORING LOG REVIEW I have reviewed this document and based on my inquiry of the person or persons who manage the system or those persons directly responsible for gathering the information, to the best of my knowledge and belief, the information submitted is, true accurate, and complete. Water pollution control manager name National Weather Service precipitation data for compliance storm exceedance attached to this log submittal? D Yes D No Water pollution control manager signature Date STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION WEATHER MONITORING LOG CEM-2041 (NEW 5/2012) GENERAL INFORMATION Instructions • The information shown on this form is required for projects with either a Stormwater Pollution Prevention Plan (SWPPP) or Water Pollution Control Program (WPCP) to document weather forecast for the project site. Use this weather monitoring log to record daily weather information for the project site location. Complete the weather monitoring log each working day. If the project is a calendar-day project, for example, a seven-working-day week, attach an additional copies of the second page so you can report all seven days. Submit Weather Monitoring Logs to the resident engineer within five working days of the ending date shown on the weather monitoring log. • For verifying exceedance of compliance storm, locate the National Weather Service (NWS) automated weather station nearest the project site. NWS weather station locations are available at: http://www.wrh.noaa.gov/sto/obsmap.php. • Print out precipitation data for the nearest NWS weather station for any storm event that exceeds the compliance storm event. NWS weather station precipitation data is available at: http://www.cnrfc.noaa.gov/awipsProducts/RNOHYDRSA.php. FORM Contract Number/Co/Rte/PM For local agency encroachment permit projects write the encroachment permit number in the Contract Number field. Project Identifier Number For projects without a Project Identification Number, write N/A in the field. WDID Number For projects with Water Pollution Control Program (WPCP) enter "WPCP" in this field. Enter the project site street address including city and state or the latitude and longitude used to obtain NWS forecast. Weekly Reporting Period Enter the first and last working day for the reporting period Enter precipitation information during working hours at least every two hours. 1. Time 2. Rain gauge reading r 3. Storm event cumulative precipitation amount Using the amounts of precipitation for each two-hour period during working hours and the amount of precipitation during non-working hours to determine the cumulative amount of precipitation for a storm event, and record the amount on the form . Determine if the forecasted cumulative amount of precipitation for the storm event is one-half inch or greater, and check the appropriate box. Compliance Storm Event Compliance Storm Event for Risk Level 3 project site discharges is determined by using the following maps: http://www.wrcc.dri.edu/pcpnfreg/nca5y24.gif http://www.wrcc.dri.edu/pcpnfreg/sca5y24.gif ATS Compliance Storm Event Compliance Storm Event for ATS discharge compliance is determined using the following map: http://www. wrcc.dri. ed u/pcpnfreg/nca 1 0y2 4.gif http://www. wrcc. dri. ed u/pcpnfreg/sca 1 0y24.g if If the storm event exceeds the compliance storm event, verification of compliance storm event is required based on nearby governmental rain gauge readings. Enter the project site street address including city and state or the latitude and longitude used to determine the nearest NWS weather station and weather station identification. J STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION WEATHER MONITORING LOG CEM-2041 (NEW 5/2012) Instructions, continued RAIN GAUGE REQUIREMENTS • The gauge must be monitored every day when any amount of rain has fallen in the previous 24 hours. The first reading each day should occur at approximately the same time to provide a 24-hour storm amount. Capture precipitation data in the early morning after storm events because accumulated precipitation will quickly evaporate when the weather clears. The rain gauge monitoring procedure is as follows: 1. At the specified time of day, read the amount of captured precipitation. The water in the gauge is likely to appear rounded at the surface when observed at eye level-a phenomenon called a meniscus caused by water tension. Read the gauge at the center of the meniscus. 2. Record the reading, including units (inches), before removing the gauge from its base. After recording the value, double-check your reading, empty the gauge, and reset it. 3. For additional readings taken during the day, do not empty the gauge after midday readings. Record the time and the reading on this form. For midday readings, the amount of precipitation entered into the "Project Site Rain Gauge Reading" column is cumulative for the day since the gauge was not emptied during this period. { r l { I J { I r I I I I Appendix F CEM-2034 Stormwater Best Management Practices Status Report f STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION STORMWATER BEST MANAGEMENT PRACTICES STATUS REPORT CEM-2034 (NEW 9/2010) PROJECT INFORMATION NAME AND SITE ADDRESS CONTRACTOR NAME AND ADDRESS Water pollution control manager (print name and sign) Submitted by contractor (print name and sign) Page 1 of 4 CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDID NUMBER PROJECT SITE RISK LEVEL □ Risk Level 1 □ Risk Level 2 □ Risk Level 3 Date Date Provide a weekly list of stormwater best management practices on the stormwater pollution prevention plan that are active on the project site. No. 1 2 Stormwater Best Management Practices Status Location Disturbed soil area Active disturbed soil area Inactive disturbed soil area acres acres acres --------- BMP Name BMPID Quantity Installed Quantity to be To Date Installed Next Week Location Disturbed soil area Active disturbed soil area Inactive disturbed soil area acres acres acres --------- BMP Name BMP ID Quantity Installed Quantity to be To Date Installed Next Week ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. { STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION STORMWATER BEST MANAGEMENT PRACTICES STATUS REPORT CEM-2034 (NEW 9/2010) PROJECT INFORMATION NAME AND SITE ADDRESS CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDID NUMBER No. Stormwater Best Management Practices Status, continued Location Disturbed soil area Active disturbed soil area acres acres ------ BMP Name BMPID Quantity Installed --To Date Location Disturbed soil area Active disturbed soil area acres acres ------ BMP Name BMPID Quantity Installed --To Date Page 2 of 4 Inactive disturbed soil area acres --- Quantity to be Installed Next Week Inactive disturbed soil area acres --- Quantity to be Installed Next Week ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. I ( r STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION STORMWATER BEST MANAGEMENT PRACTICES STATUS REPORT CEM-2034 (NEW 9/2010) PROJECT INFORMATION NAME AND SITE ADDRESS CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDID NUMBER No. Stormwater Best Management Practices Status, continued Location Disturbed soil area Active disturbed soil area acres acres ------ BMP Name BMPID Quantity Installed --To Date Location Disturbed soil area Active disturbed soil area acres acres ------ BMP Name BMP ID Quantity Installed --To Date Location Disturbed soil area Active disturbed soil area acres acres ------ BMP Name BMPID Quantity Installed --To Date Location Disturbed soil area Active disturbed soil area acres acres ------ BMP Name BMPID Quantity Installed --To Date Page 3 of 4 Inactive disturbed soil area acres --- Quantity to be Installed Next Week Inactive disturbed soil area acres --- Quantity to be Installed Next Week Inactive disturbed soil area acres --- Quantity to be Installed Next Week Inactive disturbed soil area acres --- Quantity to be Installed Next Week ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION STORMWATER BEST MANAGEMENT PRACTICES STATUS REPORT CEM-2034 (NEW 9/2010) General Information Page 4 of 4 The water pollution control manager must oversee preparation of the best management practices status report and submit a copy of the BMP status report weekly. Attach additional copies of page 2 and page 3 of this form to include all required locations. Insert consecutive numbers for each location when using page 2 or page 3 of this form BMP Name BMPID BMP Name Temporary Soil Stabilization Non-Stormwater Management Preservation of existing vegetation SS-02 Water conservation practices Hydraulic mulch SS-03 Dewatering operations Hydroseeding SS-04 Paving and grinding operations Soil binders SS-05 Temporary stream crossing Straw mulch SS-06 Clear water diversion Geotextiles, mats, plastic covers, and lined ditches SS-07 Illegal connection or discharge detection and reporting Wood mulching SS-08 Potable water and irrigation Earth dikes, drainage swales and lined ditches SS-09 Vehicle and equipment cleaning Outlet protection and velocity dissipation devices SS-10 Vehicle and equipment fueling Slope drains SS-11 Vehicle and equipment maintenance Streambank stabilization SS-12 Pile-driving operations Temporary Sediment Control Concrete curing Silt fence SC-01 Material and equipment use over water Sediment or distilling basin SC-02 Concrete finishing Sediment trap SC-03 Structure demolition or removal.over or adjacent to water Checkdams SC-04 Waste Management and Pollution Control Fiber rolls SC-05 Material delivery and storage Gravel bag berm SC-06 Material use Sandbag barrier SC-08 Stockpile management Straw bale barrier SC-09 Spill prevention and control Storm drain inlet protection SC-10 Solid waste management Wind Erosion Control Hazardous waste management Wind erosion control WE-01 Contaminated soil management Tracking Controls Concrete waste management Stabilized construction entrance and exit TC-01 Sanitary or septic waste management Stabilized construction roadway TC-02 Liquid waste management Entrance and exit lire wash TC-03 Street sweeping SC-07 ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-641 0 or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. BMPID NS-01 NS-02 NS-03 NS-04 NS-05 NS-06 NS-07 NS-08 NS-09 NS-10 NS-11 NS-12 NS-13 NS-14 NS-15 WM-01 WM-02 WM-03 WM-04 WM-05 WM-06 WM-07 WM-08 WM-09 WM-10 f l r l t l ( r l ( ( I Appendix G CEM-2030 Stormwater Site Inspection Report ( ( ( f { ( I ( ( r l ( Appendix H CEM-2035 Stormwater Site lnpsection Report Corrective Actions Summary I ( l l ( STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION STORMWATER SITE INSPECTION REPORT CORRECTIVE ACTIONS SUMMARY ::EM-2035 (REV 2/2012) PROJECT INFORMATION NAME AND SITE ADDRESS CONTRACTOR NAME AND ADDRESS Page 1 of 2 CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDID NUMBER PROJECT SITE WATER SWPPP PROJECT SITE RISK LEVEL POLLUTION CONTROL □ □ WPCP SWPPP □ □ □ Risk Level 1 Risk Level 2 Risk Level 3 □ N/A. Project resides in the Lake Tahoe Hydrologic Unit and is regulated under Order No. R6T-2011-0019, NPDES No. CAG616002. Submitted by contractor (print and sign name) Date Daily Site Inspection of Best Management Practices List daily inspections for at least the previous four days. Daily inspection performed by ,□ate Any corrective actions listed on inspection reports? YES NO □ □ □ □ □ □ □ □ If yes, are corrective actions Date shown on shown on form CEM-2035? corrective action form YES NO □ □ □ □ □ □ □ □ Implement required actions identified in a Stormwater Site Inspection Report Summary as soon as possible, but actions must begin within 72 hours of the site inspection, or complete before the next predicted rain event, whichever is sooner if in the Lake Tahoe Hydrologic Unit. Corrective action Verification of Stormwater Site Inspection Corrective Actions number BMP Type Location . 1 Required Action Comments Date Completed I Verified by (print name) I Verified by (signature) BMP Type Location 2 Required Action Comments Date Completed I Verified by (print name) !Verified by (signature) BMP Type Location 3 Required Action Comments Date Completed I Verified by (print name) !Verified by (signature) BMP Type Location 4 Required Action Comments Date Completed I Verified by (print name) I Verified by (signature) Appendix I CEM-2061 Notice of Discharge Report r l r STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION NOTICE OF DISCHARGE REPORT CEM-2061 (REV. 2/2012) PROJECT INFORMATION NAME AND SITE ADDRESS CONTRACTOR NAME AND ADDRESS Page 1 of 4 CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDID NUMBER PROJECT SITE RISK LEVEL □ Risk Level 1 □ Risk Level 2 □ NIA Project resides in the Lake Tahoe Hydrologic Unit and is regulated under Order No. RST-2011-0019, NPDES No. CAG616002. □ Risk Level 3 Submitted by contractor (print and sign name) I Date Notice of Discharge General Information Location Date discharge discovered Discharge type Exceedance of applicable water quality standard Discharge identified Discharge discovered Discharge samples □ Stormwater □ Turbidity by stormwater visual by contractor during taken? site inspection? daily work? □ Authorized non-stormwater □ pH □YES □YES □YES □ Non-authorized non-stormwater □ □NO □No □No Discharge identified by Regional Discharge identified by State Date and time water pollution control manager notified of discharge Water Quality Control Board? Water Resources Control Board? □YES □YES Date and time resident engineer notified of discharge □No □NO Storm Event Information Complete this section for stormwater discharges Start of storm event End of storm event Duration of storm event Storm event precipitation amount recorded from Date Date Hours : Minutes. site rain gauge inches Time Time Notice of Discharge Information The nature and cause of the water quality standard exceedance, base on a visual observation of the discharge location BMPs currently installed at the location of the discharge Additional BMPs that will be implemented to prevent or reduce pollutants causing or contributing to exceedance of a water quality standard Implementation schedule for additional BMPs Storm event precipitation amount recorded from governmental rain gauge inches Photooraohs □YES □No □YES □NO □YES □NO STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION NOTICE OF DISCHARGE REPORT CEM-2061 (REV. 2/2012) PROJECT INFORMATION NAME AND SITE ADDRESS CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDID NUMBER Notice of Discharge Information (continued) Maintenance or repair of BMPs Implementation schedule for BMPs maintenance or repair Other required corrective actions Implementation schedule for corrective actions Summary of actions taken to reduce the pollutants causing or contributing to the water quality standard exceedance Sample location Identification number Samples collected by Sampling and Analysis Results Required when discharge samples are taken Date of sampling Date of analysis Page 2 of 4 Photo ra hs □YES □No □YES □NO Samples analyzed by Dale and time water pollution control manager notified of results Analyzer phone number Date and time resident engineer notified of results Sample Identification Sample Collection Time Storm Event Precipitation Analysis L___J Amount at Sample Time (inches) Analysis Information Meter manufacturer Model number Serial number Calibration date Analytical method Method reporting unit Method detection limit Note: Meter calibration information available in the SWPPP files. J STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION NOTICE OF DISCHARGE REPORT CEM-2061 (REV. 2/2012) PROJECT INFORMATION NAME AND SITE ADDRESS CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDID NUMBER Sampling and Analysis Results Required when when run-on or upgradient samples are taken Run-on or upgradient samples taken? Sample location Identification number □YES □No Sample Identification Sample Collection Time Storm Event Precipitation Amount at Sample Time (inches) Notice of Discharge Report Certification Page 3 of 4 Date of sampling Analysis ( ) I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system or those persons directly responsible for gathering the information, to the best of my knowledge and belief, the information submitted is true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations. Water pollution control manager name Date Water pollution control manager signature Accepted by resident engineer (name) Date Resident engineer signature Discharge reported by telephone or email to the Regional Water Quality Control Board Date discharge reported to RWQCB Resident engineer intials (RWQCB) within 48 hours of discovery? OYES □No Notice of Discharge Report submitted to RWQCB within 14 days (3 days for District 7 Date report submitted to RWQCB Resident engineer intials and District 11 )? □YES □NO Discharge reported orally to the Lahontan RWQCB within 24 hours of discovery? Date called Lahonlan RWQCB Resident engineer intials □YES □NO Electronic submittal of NEL excedance sample results to Lahontan RWQCB and SMARTS Dale report submitted Resident engineer intials within 5 business days? □YES □NO STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION NOTICE OF DISCHARGE REPORT CEM-2061 (REV. 2/2012) Page 4 of 4 ' . • • I : r . • • • • • • f Instructions General Information This form is required for compliance with provisions in Section C-2, "Receiving Water Limitations for Construction," of the National Pollutant Discharge Elimination System (NPDES) Permit Statewide Storm Water Permit and Waste Discharge Requirements (WDRs) for the State of California, Department of Transportation (Caltrans), Order No. 99-06-DWQ, NPDES No. CAS000003. This form is to be completed when the contractor, Caltrans, State Water Resources Control Board, or Regional Water Quality Control Board staff determines that stormwater discharges, authorized non-stormwater discharges, or non-authorized, non-stormwater discharges are causing or contributing to an exceedance of an applicable water quality standard. Water quality standards are contained in the Statewide Water Quality Control Plan or applicable Regional Water Quality Control Boards (RWQCBs) Basin Plan. Sampling guidance is found in the current edition of the Construction Site Monitoring Program Guidance Manual. Include a copy of the completed form in the project Storm Water Pollution Prevention Plan (SWPPP) files. Form Project Identifier Number Caltrans projects starting July 1, 2010, will have a project identifier number. For projects without a number, write N/A in the field. Contract Number/Co/Rte/PM For encroachment permit projects, write the local agency or private entity encroachment permit number in the contract number field. Storm Event Information Leave section blank if box is checked for either authorized or non-authorized non-stormwater discharge. Discharge Information Do not leave any subsection blank. Caltrans permit specifically requires Caltrans to submit the information in this section to RWQCBs. For non-stormwater discharges, describe the construction operation or activity that caused the discharge. Sampling and Analysis Results Leave this section blank if the no box is checked for discharge samples taken. Analysis Results Analytical results less than the method detection limit shall be reported as "Less than the method detection limit." Analysis Information Leave section blank if the no box is checked for discharge samples taken? Addition Information Leave run-on sample identification blank if no box is checked for run-on samples taken. ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 9581 4. f I f J J J l I Appendix J CEM-2065 Notice of Discharge Log r STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION NOTICE OF DISCHARGE LOG INSTRUCTIONS CEM-2065 (REV. 2/2012) PROJECT INFORMATION NAME AND SITE ADDRESS CONTRACTOR NAME AND ADDRESS SUBMITTED BY CONTRACTOR (PRINT AND SIGN NAME) CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDID NUMBER PROJECT SITE RISK LEVEL □ Risk Level 1 □ □ Risk Level 2 □ Risk Level 3 NOTICE OF DISCHARGE LOG Date Discharge Location Cause of Discharge Description of Material(s) Discharged Page 1 of 2 NIA. Project resides in the Lake Tahoe Hydrologic Unit and is regulated under Order No. R6T-2011-0019, NPDES No. CAG616002. Estimated Quality of Discharge Date RWQCB Notified ·················•·••·····················'----------~----------~----------~---------~---··--·-········-··--·-··-··-··-··-·· ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. r STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION NOTICE OF DISCHARGE LOG INSTRUCTIONS CEM-2065 (REV. 2/2012) Instructions GENERAL INFORMATION Page 2 of 2 • The information shown on this form is required for projects with either a Stormwater Pollution Prevention Plan (SWPPP) or Water Pollution Control Program (WPCP) to document discharges. • Use this CEM-2065 to log discharges including Stormwater, authorized non-stormwater, and non-authorized non-stormwater discharges with an exceedance of an Applicable Water Quality Standard • Log all discharge incidents reported on forms: CEM-2061, Notice of Discharge Report CEM-2062, Numeric Action Level Exceedance Report CEM-2063, Numeric Effluent Limitation Violation Report The resident engineer will notify the Regional Water Quality Control Board and record the date notified. FORM Contract Number/Co/Rte/PM For local agency encroachment permit projects write the encroachment permit number in the Contract Number field. Project Identifier Number Caltrans projects starting July 1, 2010, will have a Project Identifier Number. For projects without a project identifier number write N/A in the field. WDID Number For projects with Water Pollution Control Program enter "WPCP" in this field. • Enter information about discharge incidents from forms: CEM-2061, Notice of Discharge Report CEM-2062, Numeric Action Level Exceedance Report CEM-2063, Numeric Effluent Limitation Violation Report CEM-2062T, Numeric Action Level Exceedance Report-Lake Tahoe Hydrologic Unit CEM-2063T, Numeric Effluent Limitation Violation Report-Lake Tahoe Hydrologic Unit • The resident engineer will notify the Regional Water Quality Control Board and record the date notified. f I J I I ( I r Appendix K CEM-2070 SWPPP/WPCP Annual Certification of Compliance I STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION SWPPP/WPCP ANNUAL CERTIFICATION OF COMPLIANCE CEM-2070 (REV. 2/2012) PROJECT INFORMATION NAME AND SITE ADDRESS CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDID NUMBER CONTRACTOR NAME AND ADDRESS PROJECT SITE WATER SWPPP PROJECT SITE RISK LEVEL POLLUTION CONTROL Page 1 of 4 □ □ WPCP SWPPP □ □ □ Risk Level 1 Risk Level 2 Risk Level 3 □ N/A. Project resides in the Lake Tahoe Hydrologic Unit and is regulated under Order No. R6T-2011-0019, NPDES No. CAG616002. Stormwater Pollution Prevention Plan (SWPPP)/Water Pollution Control Program (WPCP) Annual Certification of Compliance Water Pollution Control Manager Certification This certification for the project site is based on an inspection of the project site conducted on (date) ------------- I certify based on my inspection of the project site that: OYes OYes Water pollution control measures are being implemented in accordance with the SWPPP or WPCP approved for the project, including approved SWPPP/WPCP amendments. The project site and activities thereon are in compliance with the Caltrans Statewide NPDES Permit No. CAS000003, the NPDES General Permit for Stormwater Discharges Associated wi_th Construction and Land Disturbance Activities, Order No. 2009-00009-DWQ, NPDES Permit No. CAS000002, or local NPDES permit, whichever is applicable. Contractor water pollution control manager signature Date Contractor water pollution control manager name Phone number Contractor Annual Certification of Compliance I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to ensure that qualified personnel property gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system or those directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief true, accurate, and complete. I am aware that significant penalties exist for submitting false information, including the possibility of fine and imprisonment for knowing violations. Contractor signature Date Contractor name Phone number Title ADA Notice For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916) 654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814. I r STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION SWPPP/WPCP ANNUAL CERTIFICATION OF COMPLIANCE CEM-2070 (REV. 2/2012) PROJECT INFORMATION NAME AND SITE ADDRESS CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDID NUMBER CONTRACTOR NAME AND ADDRESS PROJECT SITE WATER SWPPP PROJECT SITE RISK LEVEL POLLUTION CONTROL Page 2 of 4 □ □ WPCP SWPPP □ □ □ Risk Level 1 Risk Level 2 Risk Level 3 □ N/A. Project resides in the Lake Tahoe Hydrologic Unit and is regulated under Order No. RST-2011-0019, NPDES No. CAG616002. Stormwater Pollution Prevention Plan (SWPPP)/Water Pollution Control Program (WPCP) Annual Certification of Compliance Required for Private Entity Administered Projects Private Entity Legally Responsible Person Annual Certification of Compliance I certify that the project is in compliance with the project site approved Stormwater Pollution Prevention Plan or Water Pollution Control Program including approved amendments. The project site and activities thereon are in compliance with the Caltrans Statewide NPDES Permit No. CAS000003, the NPDES General Permit for Stormwater Discharges Associated with Construction Land Disturbance Activities, Order No. 2009-00009-DWQ, NPDES Permit No. CAS000002, or local NPDES permit, as well as, the Lake Tahoe Hydrologic Unit Permit, order No. RST-2011-0019, NPDES No. CAG--616002, whichever is applicable I certify under a penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to ensure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system or those directly responsible for gathering the information, the information submitted, to the best of my knowledge and belief true, accurate, and complete. I am aware that significant penalties exist for submitting false information, including the possibility of fine and imprisonment for knowing violations. Legally responsible person signature Date Legally responsible person name Phone number Title I I l I STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION SWPPP/WPCP ANNUAL CERTIFICATION OF COMPLIANCE CEM-2070 (REV. 2/2012) PROJECT INFORMATION NAME AND SITE ADDRESS CONTRACT NUMBER/CO/RTE/PM PROJECT IDENTIFIER NUMBER WDID NUMBER Resident Engineer Approval of Annual Certification of Compliance An inspection of the project site for annual certification of compliance was conducted on {date) Annual Certification of Compliance project site inspection conducted by I certify that I or personnel acting under my direction and supervision have inspected the project site and find the following: OYes OYes Water pollution control measures are being implemented in accordance with the SWPPP or WPCP approved for the project, including approved SWPPP/WPCP amendments. Page 3 of 4 The project site and activities thereon are in compliance with the Caltrans Statewide NPDES Permit No. CAS000003, the NPDES General Permit for Stormwater Discharges Associated with Construction and Land Disturbance Activities, Order No. 2009-00009-DWQ, NPDES Permit ! l. No. CAS000002, Lake Tahoe Hydrologic Unit Permit, order No. RST-2011-0019, NPDES No. CAG-616002, whichever is applilcable. ---------------The box above is checked "no" based on the project site annual certification inspection, and the following corrective actions are necessary for the project to be in compliance with SWPPP/WPCP or NPDES Permits I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to ensure that qualified personnel property gather and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system or those directly responsible for gathering the information, the information, to the best of my knowledge and belief, is true, accurate, and complete. I am aware that significant penalties exist for submitting false information, including the possibility of fine and imprisonment for knowing violations. Resident engineer signature Date of approval Resident engineer name Phone number Required for Local Agency or Private Entity-Administered Project Caltrans Oversight Engineer's Concurrence With Annual Certification of Compliance I, or personnel acting under my direction and supervision, have reviewed this Annual Certification of Compliance and concur that the project is in compliance with SWPPP or WPCP approved for the project, including approved SWPPP/WPCP amendments and applicable NP DES Permits. Oversight engineer signature Date of concurrence Oversight engineer name Phone number