Form CEM-2058 "Stormwater Meter Calibration Record - Specialty Meters" - California

What Is Form CEM-2058?

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-2058 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-2058 "Stormwater Meter Calibration Record - Specialty Meters" - California

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
STORMWATER METER CALIBRATION RECORD - SPECIALTY METERS
CEM-2058 (REV 12/2013)
Page 1 of 3
PROJECT INFORMATION NAME AND SITE ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFIER NUMBER
WDID
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
Risk Level 3
No. R6T-2011-0019, NPDES No. CAG616002.
SUBMITTED BY CONTRACTOR (PRINT AND SIGN NAME)
DATE
Meter
Multi-meter:
YES
NO
Meter Manufacturer
Meter Model Number
Meter Serial Number
Conductivity Meter Calibration Date
Initial Calibration
Re-Calibration
Drift Check
Standard
Cal Standard
Time
Time
Time
Solution
Solution
Notes
Initials
(uS/cm)
Expiration Date
Acceptable
Cal
Read
Cal
Read
Read
Performance
Meter Manufacturer
Meter Model Number
Meter Serial Number
Dissolved Oxygen Meter Calibration Date
Initial Calibration
Re-Calibration
Drift Check
Cal Standard
Time
Time
Time
Standard
Solution
Notes
Initials
Expiration Date
Acceptable
Cal
Read
Cal
Read
Read
Performance
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
STORMWATER METER CALIBRATION RECORD - SPECIALTY METERS
CEM-2058 (REV 12/2013)
Page 1 of 3
PROJECT INFORMATION NAME AND SITE ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFIER NUMBER
WDID
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
Risk Level 3
No. R6T-2011-0019, NPDES No. CAG616002.
SUBMITTED BY CONTRACTOR (PRINT AND SIGN NAME)
DATE
Meter
Multi-meter:
YES
NO
Meter Manufacturer
Meter Model Number
Meter Serial Number
Conductivity Meter Calibration Date
Initial Calibration
Re-Calibration
Drift Check
Standard
Cal Standard
Time
Time
Time
Solution
Solution
Notes
Initials
(uS/cm)
Expiration Date
Acceptable
Cal
Read
Cal
Read
Read
Performance
Meter Manufacturer
Meter Model Number
Meter Serial Number
Dissolved Oxygen Meter Calibration Date
Initial Calibration
Re-Calibration
Drift Check
Cal Standard
Time
Time
Time
Standard
Solution
Notes
Initials
Expiration Date
Acceptable
Cal
Read
Cal
Read
Read
Performance
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
STORMWATER METER CALIBRATION RECORD - SPECIALTY METERS
CEM-2058 (REV 12/2013)
Page 2 of 3
PROJECT INFORMATION NAME AND SITE ADDRESS
CONTRACT NUMBER/CO/RTE/PM
PROJECT IDENTIFIER NUMBER
WDID NUMBER
Meter Manufacturer
Meter Model Number
Meter Serial Number
Meter Calibration Date
Initial Calibration
Re-Calibration
Drift Check
Cal Standard
Time
Time
Time
Standard
Solution
Notes
Initials
Expiration Date
Acceptable
Cal
Read
Cal
Read
Read
Performance
Meter Manufacturer
Meter Model Number
Meter Serial Number
Meter Calibration Date
Initial Calibration
Re-Calibration
Drift Check
Cal Standard
Time
Time
Time
Standard
Solution
Notes
Initials
Expiration Date
Acceptable
Cal
Read
Cal
Read
Read
Performance
Notes
Date
Review
I have reviewed this document and, based on my inquiry of the person or persons who manage the system of those persons directly responsible for gathering the information, to the
best of my knowledge and belief, the information submitted is true, accurate, and complete.
Water Pollution Control Manager
Date
Water Pollution Control Manager Signature
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
STORMWATER METER CALIBRATION RECORD - SPECIALTY METERS
CEM-2058 (REV 12/2013)
Page 3 of 3
Instructions
General Information
Projects with a Construction Site Monitoring Program require the information on this form as part of the Stormwater Pollution Prevention Plan for specialty
stormwater analysis meter calibration if a specialty meter was used. This form is not intended to be used with a turbidity or pH meter.
Completed forms shall be filed in project file category 20.55, Field Testing Equipment Maintenance and Calibration Records.
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.
Acceptable performance for conductivity drift is ±10 percent, and acceptable performance for dissolved oxygen is ±10 percent.
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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