Form CEM-2063 "Numeric Effluent Limitation Violation Report - Ats Discharges" - California

What Is Form CEM-2063?

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 December 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-2063 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-2063 "Numeric Effluent Limitation Violation Report - Ats Discharges" - California

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NUMERIC EFFLUENT LIMITATION VIOLATION REPORT - ATS DISCHARGES
CEM-2063 (REV 12/2013)
Page 1 of 3
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
Risk Level 3
SUBMITTED BY CONTRACTOR (PRINT AND SIGN NAME)
DATE
Numeric Effluent Limitation Violation Information
Attach form CEM-2052 or lab results
Storm Event Information
Attach a copy of the governmental rain gauge information.
Start of storm event
End of storm event
Duration of storm event
Storm event precipitation
Storm event precipitation
amount recorded from
amount recorded from
site rain gauge
governmental rain gauge
Date
Date
Hours : Minutes
inches
inches
Time
Time
Storm event 24-hour maximum
Storm event 24-hour maximum
ATS Compliance storm
ATS Compliance storm exception
precipitation amount recorded
precipitation amount from
(10-year, 24-hour storm)
(10-year, 24-hour storm)
from onsite rain gauge
governmental rain gauge
Yes
inches
inches
inches
No
Additional Information
Run-on samples taken?
Receiving water samples taken?
Yes
Yes
No
No
Run-on sample identification
Receiving water sample identification
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.
NUMERIC EFFLUENT LIMITATION VIOLATION REPORT - ATS DISCHARGES
CEM-2063 (REV 12/2013)
Page 1 of 3
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
Risk Level 3
SUBMITTED BY CONTRACTOR (PRINT AND SIGN NAME)
DATE
Numeric Effluent Limitation Violation Information
Attach form CEM-2052 or lab results
Storm Event Information
Attach a copy of the governmental rain gauge information.
Start of storm event
End of storm event
Duration of storm event
Storm event precipitation
Storm event precipitation
amount recorded from
amount recorded from
site rain gauge
governmental rain gauge
Date
Date
Hours : Minutes
inches
inches
Time
Time
Storm event 24-hour maximum
Storm event 24-hour maximum
ATS Compliance storm
ATS Compliance storm exception
precipitation amount recorded
precipitation amount from
(10-year, 24-hour storm)
(10-year, 24-hour storm)
from onsite rain gauge
governmental rain gauge
Yes
inches
inches
inches
No
Additional Information
Run-on samples taken?
Receiving water samples taken?
Yes
Yes
No
No
Run-on sample identification
Receiving water sample identification
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.
NUMERIC EFFLUENT LIMITATION VIOLATION REPORT - ATS DISCHARGES
CEM-2063 (REV 12/2013)
Page 2 of 3
PROJECT INFORMATION NAME AND SITE ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFIER NUMBER
WDID NUMBER
Numeric Effluent Limitation Violation Report 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 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 person 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
For Caltrans Use
Resident engineer name
Date
Resident engineer signature
Numeric Effluent Limitation Violation Report submitted to State Board SMARTS
Date input
Resident engineer initials
database within 24 hours after NEL exceedance was identified?
Yes
No
All storm event sampling results submitted to State Water Board SMARTS database
Date input
Resident engineer initials
within 5 days after the conclusion of the storm event?
Yes
No
Notice of Discharge Reporting
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?
YES
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
NUMERIC EFFLUENT LIMITATION VIOLATION REPORT - ATS DISCHARGES
CEM-2063 (REV 12/2013)
Page 3 of 3
Instructions
General Information
This form is required for compliance with provisions for Numeric Effluent Limitation (NEL) Violation Report in Attachment F of 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, as amended by 2010-0014-DWQ and 2012-2006-DWQ NPDES No. CAS000002.
Sampling guidance is found in the Caltrans, Construction Site Monitoring Program Guidance Manual, latest edition.
When the daily average of effluent samples analysis results exceeds an applicable NEL, submit the NEL Violation Report to the
State Water Resources Control Board (SWRCB), Storm Water Multi Application and Report Tracking System (SMARTS) within 24 hours after a NEL
Exceedance has been identified.
When the daily average of effluent samples analysis results exceeds an applicable NEL, submit all storm event sampling results to the SWRCB SMARTS
within 5 days after the conclusion of the storm event.
Regional Water Quality Control Boards have the authority to require the submittal of a NEL Violation Report.
You may submit a NEL Violation Report to RWQCB instead of a Notice of Discharge Report.
Include a copy of the completed form in the project Storm Water Pollution Prevention Plan (SWPPP) files.
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 (PIN). For projects without a PIN, write N/A in the field.
Storm Event Precipitation Amount
Record amount of precipitation from onsite and government rain gauges.
Analysis Results
Analytical results that are less than the method detection limit shall be reported as "Less than the method detection limit."
Compliance Storm Event
The 10-year, 24-hour storm (expressed in tenths of an inch of rainfall), as determined by using the maps.
http://www.wrcc.dri.edu/pcpnfreq/nca10y24.gif
http://www.wrcc.dri.edu/pcpnfreq/sca10y24.gif
Compliance storm verification must be done by reporting the onsite rain gauge readings as well as nearby governmental rain gauge readings. Attach a copy of
the governmental rain gauge readings to this report.
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