State of California Department of Transportation

Attachment F

Notification of Construction (NOC)

Caltrans Storm Water Quality Handbooks SWPPP/WPCP Preparation Manual Notification of Construction February 1, 2003 1 of 3 State of California – Department of Transportation (Caltrans) CP-CEM-2002 4/10/2000

NOTIFICATION OF CONSTRUCTION IN COMPLIANCE WITH CALTRANS STATEWIDE NPDES STORM WATER PERMIT Order No. 99-06 DWQ, NPDES No. CAS000003

I. IDENTIFICATION-Attach Vicinity Map, ½ size copy of Title Sheet Project Check One: Contract Number Date MM/DD/YY First Submittal or Amendment No. __ EA

City(if applicable) County Tentative Start Date Tentative End Date

Route Post Mile Kilometer Post Tentative Date SWPPP Available

II. CALIFORNIA REGIONAL WATER QUALITY CONTROL BOARDS Region 1, North Coast Region 5, Central Valley Region 6, Lahontan Region 7, Colorado River Region 2, San Francisco Bay Sacramento South Lake Tahoe Region 8, Santa Ana Region 3, Central Coast Fresno Victorville Region 9, San Diego Region 4, Los Angeles Redding III. CALTRANS DISTRICT Name/Number Project Contact

Address Position Title

City Zip Phone ( ) IV. CONSTRUCTION FIELD OFFICE- Attach Location Map Street Address Construction Contact

Physical Location if Different than address above Position Title

City State Zip Phone ( )

V. CONSTRUCTION SITE INFORMATION

Description and Type of Work

Additional related required approvals: DTSC Variance CWA 404/401 DFG 1601 NPDES/WDRs Other Describe:

Total Construction Area: Acres Hectares Total Disturbed Area: Acres Hectares

Receiving Water Name: Project In Or Adjacent to Receiving Water?: Yes No Project Discharges to?: Groundwater Infiltration Basin Location: Municipal/Other System Name:

VI. 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 assure 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 persons 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.

Signature: ______Date:

Print/Type Name: Title: STATE OF CALIFORNIA  DEPARTMENT OF TRANSPORTATION NOTIFICATION OF CONSTRUCTION (DESERT AREAS) (APPLIES TO PROJECTS BELOW ELEVATION 1200 METERS IN RWQCB 6 & 7 JURISDICTION) CEM-2004 (New 08/30/02) IN COMPLIANCE WITH CALTRANS STATEWIDE NPDES PERMIT, Order No. 99-06 DWQ, NPDES No. CAS000003

I. IDENTIFICATION – Attach Vicinity Map, ½ Size Copy of Title Sheet PROJECT NOC SUBMITTAL (Check One) CONTRACT NUMBER DATE MM/DD/YY EA First Submittal or Amendment No.______CITY (if applicable) COUNTY TENTATIVE START DATE TENTATIVE END DATE

ROUTE POST MILE KILOMETER POST TENTATIVE DATE SWPPP AVAILABLE

II. CALIFORNIA REGIONAL WATER QUALITY CONTROL BOARD

REGION 6, LAHONTAN RWQCB South REGION 7, COLORADO RIVER BASIN RWQCB VICTORVILLE OFFICE 73-720 Fred Waring Drive, Ste. 100 15428 Civic Drive, Ste 100 Palm Desert, CA 92260 Victorville, CA 92392 Ph: (760) 346-7491 Ph: (760) 241-6583 Fax: (760) 341-6820 Fax: (760) 241-7308 III. CALTRANS DISTRICT NAME/NUMBER PROJECT CONTACT

POSITION TITLE ADDRESS

CITY PHONE

IV. CONSTRUCTION OFFICE – Attach Location Map STREET ADDRESS CONSTRUCTION CONTACT

PHYSICAL LOCATION IF DIFFERENT THAN ABOVE ADDRESS POSITION TITLE

CITY STATE ZIP PHONE

V. CONSTRUCTION SITE INFORMATION DESCRIPTION AND TYPE OF WORK:

BMPS TO BE IMPLEMENTED (CHECK BOXES THAT APPLY OR ATTACH SWPPP) Temporary Soil Stabilization BMPs: Temporary Sediment Control BMPs:

SS-1 Scheduling SS-7 Geotextiles, Plastic Covers & Erosion Control Blankets SC-1 Silt Fence SC-6 Gravel Bag Berm

SS-2 Pres. of Existing Vegetation SS-8 Wood Mulching SC-2 Desilting Basin SC-7 Street Sweeping & Vacuuming

SS-3 Hydraulic Mulch SS-9 Earth Dikes/Drainage Swales & Lined Ditches SC-3 Sediment Trap SC-8 Sandbag Barrier

SS-4 Hydroseeding SS-10 Outlet Protection & Velocity Dissipation Devices SC-4 Check Dam SC-9 Straw Bale Barrier

SS-5 Soil Binders SS-11 Slope Drains SC-5 Fiber Rolls SC-10 Storm Drain Inlet Protection

SS-6 Straw Mulch

Wind Erosion Control BMPs Tracking Control BMPs Non-Storm Water Management BMPs Waste Mgmt. & Materials Pollution Control BMPs USGS COORDINATES NORTHING: EASTING:

TOTAL CONSTRUCTION AREA: ACRES HECTARES TOTAL DISTURBED AREA: ACRES HECTARES

RECEIVING WATER NEAREST PROJECT SITE: APPROXIMATE CLOSEST DISTANCE TO RECEIVING WATER?

VI. CERTIFICATION I certify under a 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 persons 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 fine and imprisonment for knowing violations.

SIGNATURE DATE

PRINT/TYPE NAME TITLE