Q Contractor to Complete and Sign First Page

Attachment D

Amendments

Attachment D

Amendments

INSTRUCTIONS:

q Contractor to complete and sign first page.

q If Caltrans is administering the project, then the Resident Engineer should sign the second page.

q If a Local Agency or Private Entity is administering the project, the Caltrans Oversight Engineer and the Local Agency / Private Entity Resident Engineer should both sign the third Page.

q Include a copy of the latest Amendment Log from WPCP Section 40 in this Attachment.

WPCP Amendment No.

Project Name:
Caltrans Contract Number:

To Be Completed by Contractor

"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."

Contractor’s Signature / Date
Contractor’s Name and Title / Contractor’s Telephone Number

For Use When Caltrans is Administering Project

For Caltrans Use Only

Resident Engineer’s Approval and

Caltrans Certification of the

Water Pollution Control Program

Amendment

Resident Engineer’s Signature / Date
Resident Engineer’s Name / Resident Engineer’s Telephone Number

For Use When Local Agency / Private Entity

is Administering Project

For Local Agency / Private Entity Use Only

Resident Engineer’s Approval and

Local Agency / Private Entity Certification of the

Water Pollution Control Program

Amendment

Resident Engineer’s Signature / Date
Resident Engineer’s Name / Resident Engineer’s Telephone Number

For Caltrans Use Only

Caltrans Oversight Engineer’s Approval and

Caltrans Certification of the

Water Pollution Control Program Amendment

Oversight Engineer’s Signature / Date
Oversight Engineer’s Name / Oversight Engineer’s Telephone Number

Caltrans Storm Water Quality Handbooks

SWPPP/WPCP Preparation Manual Amendments

March 1, 2007 3 of 3