Form CEM-2008 "Swppp/ Wpcp Amendment Certification and Acceptance" - California

What Is Form CEM-2008?

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 November 1, 2013;
  • 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-2008 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-2008 "Swppp/ Wpcp Amendment Certification and Acceptance" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
SWPPP/WPCP AMENDMENT CERTIFICATION AND ACCEPTANCE
Page of
CEM-2008 (REV 11/2013)
PROJECT INFORMATION NAME AND SITE ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFIER NUMBER
WDID NUMBER
CONTRACTOR NAME AND ADDRESS
PROJECT SITE RISK LEVEL
Risk Level 1
N/A. WPCP
Risk Level 2
N/A. Project resides in the Lake
Tahoe Hydrologic Unit and is
regulated under Order No.
Risk Level 3
R6T-2011-0019, NPDES No.
CAG616002.
Storm Water 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 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 ACCEPTANCE
RESIDENT ENGINEER NAME
PHONE NUMBER
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 445-1233,
ADA Notice
TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
SWPPP/WPCP AMENDMENT CERTIFICATION AND ACCEPTANCE
Page of
CEM-2008 (REV 11/2013)
PROJECT INFORMATION NAME AND SITE ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFIER NUMBER
WDID NUMBER
CONTRACTOR NAME AND ADDRESS
PROJECT SITE RISK LEVEL
Risk Level 1
N/A. WPCP
Risk Level 2
N/A. Project resides in the Lake
Tahoe Hydrologic Unit and is
regulated under Order No.
Risk Level 3
R6T-2011-0019, NPDES No.
CAG616002.
Storm Water 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 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 ACCEPTANCE
RESIDENT ENGINEER NAME
PHONE NUMBER
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 445-1233,
ADA Notice
TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
SWPPP/WPCP AMENDMENT CERTIFICATION AND ACCEPTANCE
Page of
CEM-2008 (REV 11/2013)
PROJECT INFORMATION NAME AND SITE ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFIER NUMBER
WDID NUMBER
Required for Private Entity Administered Projects
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
PHONE NUMBER
TITLE
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 SWPPP/ WPCP and find that it meets the requirements set forth in the contract
Special Provisions, Caltrans Standard Specifications, and the Caltrans SWPPP/WPCP Preparation Manual.
OVERSIGHT ENGINEER SIGNATURE
DATE OF AMENDMENT CONCURRENCE
OVERSIGHT ENGINEER NAME
PHONE NUMBER
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 445-1233,
ADA Notice
TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
SWPPP/WPCP AMENDMENT CERTIFICATION AND ACCEPTANCE
Page of
CEM-2008 (REV 11/2013)
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 certification.
SWPPP amendments must be certified by the approved signatory as identified in CEM-2006 or 2006T, "Legally Responsible Person Authorization
of Approved 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.
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.
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 445-1233,
ADA Notice
TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
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