Draft Wpcp Template

Water Pollution Control Program (WPCP)

Start Here … Triple Click here to insert PROJECT NAME - then TAB to next field to continue entering project specific information.
Contract No. Insert Caltrans Contract Number-then TAB to next field..

WPCP Template

INSTRUCTIONS

n Refer to the SWPPP/WPCP Instruction document for specific information on the use of the Template. The instruction document is available at: http://www.dot.ca.gov/hq/construc/stormwater/stormwater1.htm

n The title page shall have the following information:

· Title: “Water Pollution Control Program”

· Construction Project Name

· Caltrans Contract Number

· Caltrans Project Identifier Number

· If a Local Agency / Private Entity is administering the project enter the Caltrans encroachment permit number for permit issued to the public agency / private entity and the Caltrans encroachment permit number for the permit issued to the contractor

· Identification and address of Lead Agency (Caltrans or Local Agency)

· Caltrans’ Resident Engineer Name and Telephone Number

· Contractor’s Name, Address, Telephone Number and Contact Person

· Job Site Address and Telephone Number, if any

· Name of the Contractor’s Water Pollution Control Manager (WPC Manager) and Telephone Number. The WPC Manager must be either a Qualified SWPPP Developer or a Qualified SWPPP Practitioner

· If water pollution control inspector is different from the WPC Manager then insert the inspectors Name and telephone Number

· Name of the company that developed the WPCP (if it was prepared by an outside consultant), including name and title of preparer

· WPCP Date

Water Pollution Control Program (WPCP)

REQUIRED TEXT

Water Pollution Control Program (WPCP)

For

Start Here … Triple Click here to insert PROJECT NAME - then TAB to next field to continue entering project specific information.

REQUIRED TEXT FOR CALTRANS ADMINISTERED PROJECT:

Caltrans Contract Number:

Insert Caltrans Contract Number-then TAB to next field.

Caltrans Project Identifier Number:

Insert Caltrans Project Identifier Number-then TAB to next field.

REQUIRED TEXT FOR LOCAL AGENCY / PRIVATE ENTITY ADMINISTERED PROJECT:

Caltrans Encroachment Permit Number for Local Agency / Private Entity:

Insert Caltrans ENCROACHMENT PERMIT Number issued to local agency/private entity then TAB to next field.

Caltrans Encroachment Permit Number for Contractor:

Insert Caltrans ENCROACHMENT PERMIT Number issued to Contractor then TAB to next field.

REQUIRED TEXT:

Prepared for:

Insert Name of Lead Agency-then TAB.

Insert Address 1 and press ENTER to insert Address 2 or TAB to next field.

Insert City, State, ZIP-then TAB.

Insert Resident Engineer’s Name-then TAB.

Insert Resident Engineer’s Telephone Number-then TAB.

Submitted by:

Insert Contractor’s Company Name-then TAB.

Insert Address 1 and press ENTER to insert Address 2 or TAB to next field.

Insert City, State, ZIP-then TAB.

Insert Telephone-then TAB.

Insert Owner/Representative’s Name-then TAB.

Project Site Address

Insert job site address, if any-then TAB.

Insert job site telephone number, if any-then TAB.

Contractor’s Water Pollution Control Manager

Insert WPC Manager’s Name-then TAB.

Insert Telephone Number(s)-then TAB.

Contractor’s Designated Water Pollution Control Inspector (if different from WPC Manager)

Insert Inspectors Name-then TAB.

Insert Telephone Number(s)-then TAB.

WPCP Prepared by:

Insert Company Name-then TAB.

Insert Address 1 and press ENTER to insert Address 2 or TAB to next field.

Insert Telephone-then TAB.

Insert Name and Title of Preparer-then TAB.

WPCP Preparation Date

Insert Date.

Water Pollution Control Program (WPCP)

Start Here … Triple Click here to insert PROJECT NAME - then TAB to next field to continue entering project specific information.
Contract No. Insert Caltrans Contract Number-then TAB to next field..

Contents

WPCP Template 1

Section 10 WPCP Certification and Acceptance 10-1

10.1 Contractor’s Certification and Acceptance by the Resident Engineer 10-1

10.2 Amendments 10-4

10.3 Contractor’s Annual Certification and Acceptance by the Resident Engineer 10-5

Section 20 Project and Contractor Information 20-1

20.1 Project Description 20-1

20.2 Unique Site Features 20-1

20.3 Contact Information for Responsible Parties 20-2

20.4 Training 20-5

Section 30 Pollution Sources and Control Measures 30-1

30.1 Pollutant Sources 30-1

30.1.1 Inventory of Materials and Activities that May Pollute Stormwater 30-1

30.1.2 Potential Pollutants from Site Features or Known Contaminants 30-1

30.2 Soil Stabilization (Erosion Control) and Sediment Control 30-2

30.2.1 Soil Stabilization BMPs 30-3

30.2.2 Sediment Control BMPs 30-6

30.2.3 Tracking Control BMPs 30-8

30.2.4 Wind Erosion Control BMPs 30-9

30.3 Construction Site Management 30-11

30.3.1 Non-Stormwater Management BMPs 30-11

30.3.2 Waste Management and Materials Pollution Control BMPs 30-14

30.4 Water Pollution Control Drawings (WPCDs) 30-16

30.5 Water Pollution Control Schedule 30-18

Section 40 WPCP Implementation 40-1

40.1 Water Pollution Control Manager Responsibilities 40-1

40.2 Weather Forecast Monitoring 40-3

40.3 Best Management Practices Status Report 40-4

40.4 Stormwater Site Inspections and Site Visual Monitoring 40-4

40.5 Stormwater Site Inspections 40-5

40.6 Site Visual Monitoring 40-6

40.6.1 Visual Monitoring Prior To a Forecasted Storm Event 40-7

40.6.2 Visual Monitoring During Extended Forecasted Storm Event 40-7

40.6.3 Visual Monitoring Within 48 Hours After A Qualifying Rain Event Generating Site Runoff 40-8

40.6.4 Visual Monitoring Non-Stormwater Discharges 40-8

40.6.5 Visual Monitoring Documentation, Follow-up and Tracking Procedures 40-9

Section 50 WPCP Reporting Requirements 50-1

50.1 Record Keeping 50-1

50.2 Discharge Reporting 50-2

50.3 Regulatory Agency Notice or Order Reporting 50-3

50.4 Illicit Connection/Illegal Discharge Reporting 50-3

WPCP Attachments

Attachment A Water Pollution Control Drawings

Attachment B Water Pollution Control Schedule

Attachment C WPCP Amendments

Attachment D Stormwater Training Documentation

INSERT ADDITIONAL ATTACHMENT REFERENCES OR DELETE THIS LINE

INSTRUCTIONS

n Current Construction Engineering Management (CEM) forms that are to be included in the appendices are available at:

http://www.dot.ca.gov/hq/construc/forms.htm

REQUIRED TEXT

WPCP Appendices

Appendix A CEM-2008 SWPPP/WPCP Amendment Certification and Acceptance

Appendix B CEM-2009 SWPPP/WPCP Amendments Log

Appendix C CEM-2023 Stormwater Training Record

Appendix D CEM-2024 Stormwater Training Log

Appendix E Weather Forecast Monitoring Log

Appendix F CEM-2034 Stormwater Best Management Practices Status Report

Appendix G CEM-2030 Stormwater Site Inspection Report

Appendix H CEM-2035 Stormwater Site Inspection Report Corrective Actions Summary

Appendix I CEM-2061 Notice of Discharge Report

Appendix J CEM-2065 Notice of Discharge Log

Appendix K CEM-2070 SWPPP/WPCP Annual Certification of Compliance

INSERT ADDITIONAL ATTACHMENT REFERENCES OR DELETE THIS LINE

Insert Contractor’s Company Name-then TAB. Contents

Page iii

WPCP Template 07-07-11 Insert Date.

Water Pollution Control Program (WPCP)

Section 10
WPCP Certification and Acceptance

10.1 Contractor’s Certification and Acceptance by the Resident Engineer

INSTRUCTIONS

n Include a Separator and Tab for Section 10 for ready reference.

n The WPCP preparer shall certify that qualifications and certification requirements have been met.

n The WPCP shall be certified by the contractor.

n Certification shall be signed and dated by Contractor’s staff; specifically, the person responsible for overall management of the site, such as a corporate officer or person assigned the responsibility by a corporate officer, according to corporate procedures.

n Print the name, title and telephone number of the person signing the certification.

n The WPCP shall be submitted to the Resident Engineer for review and acceptance.

REQUIRED TEXT

WPCP PREPARER CERTIFICATION OF WPCP

“I certify that I have the qualifications and certifications specified for a Qualified SWPPP Developer (QSD) or Qualified SWPPP Practinoner (QSP) shown in 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, NPDES No.CAS000002, Section VII, Training Qualifications and Certification Requirements.

I certify that this WPCP meets the requirements set forth in the contract special provisions, Caltrans Standard Specifications, and the Caltrans SWPPP/WPCP Preparation Manual.

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, the information submitted, to the best of my knowledge and belief 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."

WPCP Preparer Signature / Date
WPCP Preparer Name / Telephone Number
WPCP Preparer Title

CONTRACTOR’S CERTIFICATION OF WPCP

"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, the information submitted, to the best of my knowledge and belief 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 / Telephone Number
Contractor’s Title

INSTRUCTIONS

· If Caltrans is administering the project, then the Caltrans Resident Engineer, as the authorized representative of the Department shall provide and sign the following certification upon acceptance of the WPCP.

· If a Local Agency is administering the project, then both the Local Agency Resident Engineer and the Caltrans Oversight Engineer shall provide and sign the following certification upon acceptance of the WPCP.

Is a Local Agency / Private Entity administering the project?

REQUIRED TEXT WHEN CALTRANS IS ADMINISTERING PROJECT

For Use by Caltrans Only

CALTRANS RESIDENT ENGINEER'S ACCEPTANCE OF WPCP

"I certify under a penalty of law that this document and all attachments were reviewed under my direction or supervision in accordance with a system designed to ensure that qualified personnel properly evaluated 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, to the best of my knowledge and belief 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."

This WPCP is accepted based on a review performed by myself or personnel acting under my direction. that detrermined that the WPCP meets the requirements set forth in the contract special provisions, Caltrans Standard Specifications, and the Caltrans SWPPP/WPCP Preparation Manual.

Resident Engineer’s Signature / Date of WPCP Acceptance
Insert Resident Engineer’s Name-then TAB. / Insert Resident Engineer’s Telephone Number-then TAB.
Resident Engineer's Name / Telephone Number

REQUIRED TEXT WHEN LOCAL AGENCY / PRIVATE ENTITY IS ADMINISTERING PROJECT

For Use by Local Agency / Private Entity Only

LOCAL AGENCY / PRIVATE ENTITY RESIDENT ENGINEER'S ACCEPTANCE OF WPCP

Resident Engineer’s Signature / Date of WPCP Approval
Insert Resident Engineer’s Name-then TAB. / Insert Resident Engineer’s Telephone Number-then TAB.
Resident Engineer's Name / Telephone Number

For Use by Caltrans Only

CALTRANS OVERSIGHT ENGINEER’S CONCURENCE OF WPCP

I, and/or personnel acting under my direction and supervision, have reviewed this WPCP and concur with the Resident Engineer’s findings that it meets the requirements set forth in the contract special provisions, Caltrans Standard Specifications, and the Caltrans SWPPP/WPCP Preparation Manual.

Caltrans Oversight Engineer’s Signature / Date of WPCP Concurrence
Caltrans Oversight Engineer's Name / Telephone Number

INSERT ADDITIONAL TEXT HERE OR DELETE THIS LINE (Use the “FORMAT OPTIONS” button to insert subtitles and/or paragraphs)

Insert Contractor’s Company Name-then TAB. WPCP Certification and Acceptance

Page 10-6

WPCP Template 07-07-11 Insert Date.

Water Pollution Control Program (WPCP)

10.2 Amendments

INSTRUCTIONS

n The WPCP shall be amended whenever there is a change in construction or operations that may cause the discharge of significant quantities of pollutants to surface waters, ground waters, municipal storm drain systems, or when deemed necessary by the Resident Engineer. All WPCP amendments shall be documented in letter format and include revised WPCD sheets, as appropriate. WPCP amendments shall be certified by the contractor and require approval by the Caltrans or Local Agency / Private Entity Resident Engineer (and Caltrans Oversight Engineer if applicable). Accepted amendments shall be attached to the Contractor’s on-site WPCP in Attachment C.

n The following items will be included in the amendment, as appropriate:

· who requested the amendment

· location of proposed change

· reason for change

· the original BMP proposed, if any

· the new BMP proposed

· any revised WPCDs for detail or location changes

n Include a copy of the Amendment Log in Attachment C.

n The certification form shall be included in Attachment C and shall be signed by the contractor and Resident Engineer (and Oversight Engineer if applicable) for each amendment. The signed forms shall be included with the Amendment.