Form CEM-1901 "Burial Location of Soil Containing Aerially Deposited Lead" - California

What Is Form CEM-1901?

This is a legal form that was released by the California Department of Transportation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2012;
  • The latest edition provided by the California Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CEM-1901 by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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Download Form CEM-1901 "Burial Location of Soil Containing Aerially Deposited Lead" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
BURIAL LOCATION OF SOIL CONTAINING AERIALLY DEPOSITED LEAD
CEM-1901 (REV. 01/2012)
Department of Toxic Substances Control Variance No. V09HQSCD006, Section bb, issued to Caltrans for aerially deposited lead-
containing soils requires completion of this form.
The contractor provides a training program for all personnel to complete before performing any work in areas
containing aerially deposited lead. The safety training program must meet the requirements of Title 8, California
Code of Regulations, Section 1532.1, "Lead."
Burial Location Number
Provide a unique sequential number for each location (1,2,3,4….)
Burial Location Determination Method
Check either GPS or surveyed as appropriate
Bottom Perimeter of Burial Site Location
Survey the perimeter of the bottom of each excavation at each location where aerially deposited lead will be buried. Collect a minimum of
10 survey points defining a polygon of the bottom of each location. Provide both latitude and longitude and California State Plane
Coordinates. If more points are necessary, attach an additional form and use the same burial location number.
Signature
Person collecting data
Print Name
Person collecting data
License Number
Land surveyor or civil engineer license number issued by Department of Consumer Affairs
License Expiration Date
Date of expiration for license
Survey Date
Date data was collected
Top Perimeter of Burial Site Location
Survey the perimeter of the top of aerially deposited lead-containing soil before covering. Collect a minimum of 10 survey points to define
the polygon top at each burial location. Provide both latitude, longitude and California State Plane Coordinates. If additional points are
necessary, attach an additional form and use the same burial location number.
Signature
Person collecting data
Print Name
Person collecting data
License Number
Land surveyor or civil engineer license number issued by Department of Consumer Affairs
License Expiration Date
Date of expiration for license
Survey Date
Date data was collected
Cover Type
Indicate the type of cover being placed on top of the soil containing aerially deposited lead (one foot of clean soil, pavement, or other.) If
"other" is used, explain in the blank provided (for example, "two feet of clean soil").
The contractor should verify that data entered on this form is complete and accurate. Sign the form and clearly print name, title, phone
number, and date. Send all completed forms to the resident engineer within five business days of the survey of the top perimeter being
completed at each location. Email the form to ADL@dot.ca.gov
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