Notice of Completeness

Safe Drinking Water State Revolving Fund

ENVIRONMENTAL Deliverable

NOTICE OF COMPLETENESS

This “notice of completeness” WITH THE APPROPRIATE FORMS ATTACHED must be returned to the cdph HEADQUARTERS IN SACRAMENTOno later than January 11, 2010. FAILURE TO DO SO WILL RESULT IN BYPASS OF YOUR PROJECT for CONSTRUCTION FUNDING.

THE CDPH ENVIRONMENTAL REVIEW UNIT (ERU) WILL CONTACT THE APPLICANT FOR ANY FOLLOW-UP REPORTS NECESSARY TO COMPLETE any FEDERAL “NEPA-LIKE” REQUIREMENTS, if applicable, Reports must be completed by February 4, 2010. ANY ADDITIONAL REPORTS OR SURVEYSMUST BE submitted byMarch 4, 2010. if additional reports or surveys are not submitted by MArch 4, 2010, the project will be bypassed for funding and cannot be considered for planning funding.

Project Information
Name of Applicant/Water System: ______
Project Number: ______- ______
Street Address: ______
County: ______
Mailing Address: ______
Authorized Representative: ______
Phone Number ______Email Address: ______
Documents to be submitted with this form (check applicable boxes):
Federal Crosscutting Worksheet (Enclosure 5)
(Applicable to projects with total project costs greater than $1.25 Million and/or with more than 1,000 water service connections)
AND ONE OF THE FOLLOWING
One copy of the applicant’s Final California Environmental Quality Act (CEQA) documentation including

Final version of the CEQA document (MND, Negative Dec or EIR)
Resolution or council approval of the document and the project
Stamped copy of the NOD (SCH or county clerk)
A copy of the Fish and Game filing fee receipt or “de Minimus” findings Determination Form or “No Effect” Determination Form

Worksheet for CEQA/NEPA Determination Form (public agencies only) (Enclosure 5)
Copy of the stamped NOE (SCH or county clerk)

OR
Environmental Information Form or Initial Study (private, mutual and investor-owned utilities only) (Enclosure 5)
Applicant’s Certification of Environmental Documentation
I, (authorized representative), certify the documents identified above and the attached exhibits present the data and information required for this initial evaluation to the best of my ability, and the facts, statements and information presented are true and correct to the best of my knowledge and belief.
Applicant Representative’s Signature: Date:
CDPH ERU Review and Certification of Environmental Document Completeness
(For CDPH District Office Use Only)
The CEQA documents are complete and I recommend Tier 1 – Construction Funding.
The CEQA documents are not ready to proceed and I recommend Tier 2 – Planning Funding
for the followingreasons: ______
______
______
(Please attach additional sheets if required)
The CEQA documents are incomplete and I recommend bypass to the next Funding Cycle
for the following reasons: ______
______
______
(Please attach additional sheets if required)
CDPH ERU Name: ______Phone No: ______
CDPH ERU Signature: ______Date: ______

California Department of Public Health Page 1 of 2

November 4, 2009