Form CEM-2003 "Notice of Completion of Construction" - California

What Is Form CEM-2003?

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 April 12, 2000;
  • 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-2003 by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
NOTICE OF COMPLETION OF CONSTRUCTION
CEM-2003 (NEW 4/12/2000)
IN COMPLIANCE WITH CALTRANS STATEWIDE NPDES STORM WATER PERMIT Order No. 99-06 DWQ, NPDES No. CAS000003
I. IDENTIFICATION
PROJECT NAME
CONTRACT NUMBER
TODAY'S DATE MM/DD/YYYY
EA
CITY (if applicable)
COUNTY
ROUTE
POST MILE (S)
START DATE
END DATE
II. CALIFORNIA REGIONAL WATER QUALITY CONTROL BOARDS
Region 5, Central Valley
Region 6, Lahontan
Region 7, Colorado River
Region1, North Coast
South Lake Tahoe
Region 8, Santa Ana
Region 2, San Francisco Bay
Sacramento
Victorville
Fresno
Region 9, San Diego
Region 3, Central Coast
Region 4, Los Angeles
Redding
III. CALTRANS DISTRICT
FIELD OFFICE and DISTRICT NUMBER
PROJECT CONTACT
ADDRESS
POSITION TITLE
CITY
PHONE
IV. BASIS OF COMPLETION
1. The construction job is complete and requirements met as of Date:
2. Construction activities have been suspended, as of Date:
Expected Start Up Date:
3. Site can not discharge storm water to waters of the United States Reason:
4. Discharge is now subject to NPDES Permit No.
Date:
V. DESCRIPTION OF COMPLETION (Attach site photographs)
VI. CERTIFICATION
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 to those persons directly responsible for gathering the information, the information submitted is true, accurate, and complete to the best of my knowledge and
belief. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment of knowing violations.
SIGNATURE
PRINT/TYPE NAME
DATE
TITLE
For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916)
ADA Notice
654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
NOTICE OF COMPLETION OF CONSTRUCTION
CEM-2003 (NEW 4/12/2000)
IN COMPLIANCE WITH CALTRANS STATEWIDE NPDES STORM WATER PERMIT Order No. 99-06 DWQ, NPDES No. CAS000003
I. IDENTIFICATION
PROJECT NAME
CONTRACT NUMBER
TODAY'S DATE MM/DD/YYYY
EA
CITY (if applicable)
COUNTY
ROUTE
POST MILE (S)
START DATE
END DATE
II. CALIFORNIA REGIONAL WATER QUALITY CONTROL BOARDS
Region 5, Central Valley
Region 6, Lahontan
Region 7, Colorado River
Region1, North Coast
South Lake Tahoe
Region 8, Santa Ana
Region 2, San Francisco Bay
Sacramento
Victorville
Fresno
Region 9, San Diego
Region 3, Central Coast
Region 4, Los Angeles
Redding
III. CALTRANS DISTRICT
FIELD OFFICE and DISTRICT NUMBER
PROJECT CONTACT
ADDRESS
POSITION TITLE
CITY
PHONE
IV. BASIS OF COMPLETION
1. The construction job is complete and requirements met as of Date:
2. Construction activities have been suspended, as of Date:
Expected Start Up Date:
3. Site can not discharge storm water to waters of the United States Reason:
4. Discharge is now subject to NPDES Permit No.
Date:
V. DESCRIPTION OF COMPLETION (Attach site photographs)
VI. CERTIFICATION
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 to those persons directly responsible for gathering the information, the information submitted is true, accurate, and complete to the best of my knowledge and
belief. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment of knowing violations.
SIGNATURE
PRINT/TYPE NAME
DATE
TITLE
For individuals with sensory disabilities, this document is available in alternate formats. For information call (916) 654-6410 or TDD (916)
ADA Notice
654-3880 or write Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
NOTICE OF COMPLETION OF CONSTRUCTION (NCC) INSTRUCTIONS
CEM-2003 (NEW 4/12/2000)
CALTRANS STATEWIDE NPDES PERMIT
Order No. 99-06 DWQ, NPDES CAS000003
I. IDENTIFICATION The project name, contract number, city, county, route and post mile information should be identical to that
on the Notification of Construction form. Enter the date the Completion of Construction (NCC) is submitted to the Regional Water
Quality Control Boards (RWQCB) and the start and end dates of construction.
II. CALIFORNIA REGIONAL WATER QUALITY CONTROL BOARDS. Check the box next to the appropriate
RWQCB(s).
III. CALTRANS DISTRICT. Provide the Caltrans district information and the name, title and phone of the construction contact,
which by district policy may be the resident engineer, the area senior, the program manager, National Pollution Discharge
Elimination System (NPDES) coordinator or other responsible staff. The contact should be someone who can address RWQCB
staff questions about project storm water controls or who can refer a RWQCB staff to a someone who can.
IV. BASIS OF COMPLETION. Check one of the boxes:
1. The construction project has been completed and
All elements of the Storm Water Pollution Prevention Plan (SWPPP) have been completed;
Construction materials and equipment maintenance waste have been disposed of properly;
Final stabilization requirements have been met, i.e., when all soil disturbing activities are completed and either:
a. A uniform vegetative cover with 70 percent coverage has been established or
b. Equivalent stabilization measures have been employed, (i.e., erosion resistant soil coverings or treatments).
Caltrans projects typically include erosion control on all disturbed areas, which is considered to be equivalent
stabilization.
The post-construction storm water operation and management plan is in place.
2. Construction activities have been suspended, either temporarily or indefinitely and
All elements of the SWPPP have been completed;
Construction materials and equipment maintenance waste have been disposed of properly;
All denuded areas and other areas of potential erosion are stabilized;
An operation and maintenance plan for erosion and sediment control is in place;
The date construction activities were suspended, and the expected start up date.
3. The construction site can not discharge storm water to waters of the United States. Indicate how prevention of all discharge is
ensured, and if all storm water is retained on site or collected offsite.
4. The discharge of construction storm water from the site is now subject to another NPDES general permit or an individual
NPDES permit. The general permit or individual permit NPDES number and the date coverage began should be provided.
V. DESCRIPTION OF COMPLETION
Briefly describe how the completion requirements have been met. Attach site photographs.
VI. CERTIFICATION
The permit requires information submitted be signed by the district director or a duly authorized representative. If the district
director elects to delegate signature authority, the district must first have submitted the list of authorized representatives to
the appropriate RWQCB.
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