Form CEM-2035T Stormwater Corrective Action Summary - Lake Tahoe Hydrologic Unit - California

Form CEM-2035T or the "Stormwater Corrective Action Summary - Lake Tahoe Hydrologic Unit" is a form issued by the California Department of Transportation.

Download a PDF version of the Form CEM-2035T down below or find it on the California Department of Transportation Forms website.

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STORMWATER CORRECTIVE ACTIONS SUMMARY - LAKE TAHOE HYDROLOGIC UNIT
Page 1 of 2
CEM-2035T (REV 02/2018)
PROJECT INFORMATION NAME AND SITE ADDRESS
CONTRACTOR NAME AND ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT INDENTIFICATION NUMBER
SUBMITTED BY CONTRACTOR (print and sign name)
DATE
WDID NUMBER
Implement required actions, identified in this Stormwater Corrective Actions Summary as soon as possible, but required action must be completed within 72 hours of the site inspection, or
be completed before the next predicted rain event, whichever is sooner.
Week Ending:
Water Pollution
Caltrans Resident
Best Management
Location
Required Action/Comments
Date Identified
Date Completed
Control Manager/
Engineer/Inspector
Practice Type
Inspector Initials
Initials
Water Pollution Control Manager Signature
Date
Caltrans Resident Engineer Signature
Date
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STORMWATER CORRECTIVE ACTIONS SUMMARY - LAKE TAHOE HYDROLOGIC UNIT
Page 1 of 2
CEM-2035T (REV 02/2018)
PROJECT INFORMATION NAME AND SITE ADDRESS
CONTRACTOR NAME AND ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT INDENTIFICATION NUMBER
SUBMITTED BY CONTRACTOR (print and sign name)
DATE
WDID NUMBER
Implement required actions, identified in this Stormwater Corrective Actions Summary as soon as possible, but required action must be completed within 72 hours of the site inspection, or
be completed before the next predicted rain event, whichever is sooner.
Week Ending:
Water Pollution
Caltrans Resident
Best Management
Location
Required Action/Comments
Date Identified
Date Completed
Control Manager/
Engineer/Inspector
Practice Type
Inspector Initials
Initials
Water Pollution Control Manager Signature
Date
Caltrans Resident Engineer Signature
Date
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STORMWATER CORRECTIVE ACTIONS SUMMARY - LAKE TAHOE HYDROLOGIC UNIT
Page 2 of 2
CEM-2035T (REV 08/2017)
PROJECT INFORMATION NAME AND SITE ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT INDENTIFICATION NUMBER
WDID NUMBER
Stormwater Site Inspection Report Corrective Action Summary Certification
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 assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the people who
manage the system or are 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.
Water Pollution Control Manager (print name):
Date:
Water Pollution Control Manager (signature):
Stormwater Site Inspection Report Corrective Action Summary Acceptance
Resident Engineer (print name):
Date:
Resident Engineer (signature):
Instructions
General Information
If the summary form does not have enough lines to report all required actions, use additional copies of this form's page 1 to report all
required corrective actions from an inspection form.
On page 1 of this form and additional copies of page 1, insert consecutive numbers for each required corrective action.
Required Actions
identification and complete BMP repairs or other changes as soon as possible, or before the next predicted rain event, whichever is
sooner, per the Lake Tahoe Hydrologic Unit Permit.
Daily inspections required for waste containers (covered at end of shift), tracking, and others per project specifications.
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.

Download Form CEM-2035T Stormwater Corrective Action Summary - Lake Tahoe Hydrologic Unit - California

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