DIST/CO/RTE/PM: EA/Project No: A. Environmental Documentation NEPA compliance type: CE FONSI Approval Date: EIS Approval Date: ROD Date: CEQA compliance type: CE ND/MND EIR Approval Date: Supplemental or new document needed (NEPA) Yes No Date: Addendum, Supplemental, or Subsequent (CEQA) Yes No Date: NEPA determination checked for validity/Re-evaluation Approval Date(s): (The Re-Validation form serves as the required consultation for all NEPA documentation including CEs in accordance with .) B. Do Environmental Construction Windows Apply? Yes No C. Each of the following conditions must be true in order to complete this certification: All environmental commitments that belong in this PS&E are included. All actions in this PS&E are covered by the approved environmental documentation, which remains valid. All environmental permits, licenses, agreements, and certifications (PLACs) are complete. Project PLACs are listed below: Agency Type Issue Date Expiration Date D. Environmental Commitment Record has been prepared: Date: E. Environmental Commitment Record has been updated: Yes No Date: I certify that, for environmental purposes, this project is ready to list, and, as applicable, Caltrans has fully carried out all environmental responsibilities assumed under 23 USC 326 or 23 USC 327 for this project in accordance with NEPA Assignment and applicable federal laws, regulations, and policies. Environmental Branch Chief (sign name) Date Environmental Branch Chief (print name) Changes to this PS&E submittal shall be discussed with the signature authority and may require an updated environmental certification. This project may be advertised for contract award. If the project has not been advertised within twelve months of the date of Environmental Certification, this Environmental Certification expires and a new certification or update is required. Certification expiration date is .
DIST/CO/RTE/PM: EA/Project No: A. Environmental Documentation NEPA compliance type: CE FONSI Approval Date: EIS Approval Date: ROD Date: CEQA compliance type: CE ND/MND EIR Approval Date: Supplemental or new document needed (NEPA) Yes No Date: Addendum, Supplemental, or Subsequent (CEQA) Yes No Date: NEPA determination checked for validity/Re-evaluation Approval Date(s): (The Re-Validation form serves as the required consultation for all NEPA documentation including CEs in accordance with .) B. Do Environmental Construction Windows Apply? Yes No C. Each of the following conditions must be true in order to complete this certification: All environmental commitments that belong in this PS&E are included. All actions in this PS&E are covered by the approved environmental documentation, which remains valid. All environmental permits, licenses, agreements, and certifications (PLACs) are complete. Project PLACs are listed below: Agency Type Issue Date Expiration Date D. Environmental Commitment Record has been prepared: Date: E. Environmental Commitment Record has been updated: Yes Date: No I certify that, for environmental purposes, this project is ready to list, and, as applicable, Caltrans has fully carried out all environmental responsibilities assumed under 23 USC 326 or 23 USC 327 for this project in accordance with NEPA Assignment and applicable federal laws, regulations, and policies. Environmental Branch Chief (sign name) Date Environmental Branch Chief (print name) Changes to this PS&E submittal shall be discussed with the signature authority and may require an updated environmental certification. This project may be advertised for contract award. If the project has not been advertised within twelve months of the date of Environmental Certification, this Environmental Certification expires and a new certification or update is required. Certification expiration date is .
env_certification.docx