Form CEM-2051 "Stormwater Sampling and Analysis Log - Optional" - California

What Is Form CEM-2051?

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, 2014;
  • 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-2051 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-2051 "Stormwater Sampling and Analysis Log - Optional" - California

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STORMWATER SAMPLING AND ANALYSIS LOG - OPTIONAL
Page 1 of 3
CEM-2051 (REV 1/2014)
PROJECT INFORMATION NAME AND SITE ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFIER NUMBER
WDID NUMBER
CONTRACTOR NAME AND ADDRESS
PROJECT SITE RISK LEVEL
N/A. Project resides in the Lake Tahoe
Risk Level 1
Hydrologic Unit and is regulated under Order
No. R6T-2011-0019, NPDES No. CAG616002.
Risk Level 2
Risk Level 3
SUBMITTED BY CONTRACTOR (PRINT AND SIGN NAME)
DATE
STORMWATER SAMPLING AND ANALYSIS LOG REVIEW
I have reviewed this document and based on my inquiry of the person or persons who manage the system or those persons directly responsible for gathering the information, to the
best of my knowledge and belief, the information submitted is true, accurate, and complete.
Are laboratory test results attached to this stormwater sampling and analysis log submittal?
YES
NO
Water Pollution Control Manager Signature
Date
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.
STORMWATER SAMPLING AND ANALYSIS LOG - OPTIONAL
Page 1 of 3
CEM-2051 (REV 1/2014)
PROJECT INFORMATION NAME AND SITE ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFIER NUMBER
WDID NUMBER
CONTRACTOR NAME AND ADDRESS
PROJECT SITE RISK LEVEL
N/A. Project resides in the Lake Tahoe
Risk Level 1
Hydrologic Unit and is regulated under Order
No. R6T-2011-0019, NPDES No. CAG616002.
Risk Level 2
Risk Level 3
SUBMITTED BY CONTRACTOR (PRINT AND SIGN NAME)
DATE
STORMWATER SAMPLING AND ANALYSIS LOG REVIEW
I have reviewed this document and based on my inquiry of the person or persons who manage the system or those persons directly responsible for gathering the information, to the
best of my knowledge and belief, the information submitted is true, accurate, and complete.
Are laboratory test results attached to this stormwater sampling and analysis log submittal?
YES
NO
Water Pollution Control Manager Signature
Date
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.
STORMWATER SAMPLING AND ANALYSIS LOG - OPTIONAL
CEM-2051 (REV 1/2014)
Page 2 of 3
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFIER NUMBER
WDID NUMBER
DATE
STORMWATER SAMPLING AND ANALYSIS LOG
Daily
Time
Lab
Log
Date of
Amount of
Analysis
Average
Sampling Location
Sample
Sample Identification
Analysis
Report
Number
Sampling
Precipitation
Result
Analysis
Taken
Attached
Result
Turbidity
Yes
pH
No
Turbidity
Yes
pH
No
Turbidity
Yes
pH
No
Turbidity
Yes
pH
No
Turbidity
Yes
pH
No
Turbidity
Yes
pH
No
Turbidity
Yes
pH
No
Turbidity
Yes
pH
No
STORMWATER SAMPLING AND ANALYSIS LOG - OPTIONAL
Page 3 of 3
CEM-2051 (REV 1/2014)
Instructions
General Information
The information shown on this form is required for projects with a Stormwater Pollution Prevention Plan (SWPPP) to document stormwater sampling and
analysis. The information on this form is required for the stormwater annual report for SWPPP projects.
Complete this form after every storm event that requires sampling and analysis.
Complete this form weekly for logging non-stormwater sampling and analysis, and indicate in the sampling location column the reason for non-stormwater
samples, such as sample from dewatering operation.
This form is provided as an optional management tool, to be used at the discretion of the water pollution control manager.
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.
Log No.
Log numbering should be consecutive starting from the first storm event to the last storm event for a project.
Amount of Precipitation
Enter the cumulative amount of precipitation from the storm event at the time each sample is taken.
Analysis Result
For turbidity and pH, a minimum of three samples is required to determine the daily average. If more than three daily samples are taken, use two rows to
report all samples, and report the daily average in the second row.
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