Form Exhibit 6-H - External Certifications Environmental Document Quality Control Reviews (Fillable)
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1Local Assistance Procedures Manual
EXHIBIT 6-H
External Certifications Environmental Document Quality Control Reviews
September 15, 2008
EXHIBIT 6-H E
C
E
D
Q
C
R
XTERNAL
ERTIFICATIONS
NVIRONMENTAL
OCUMENT
UALITY
ONTROL
EVIEWS
Project Name:_________________________________________
Local Assistance
SHS
DIST-CO-RTE-PM:_________________________________________ EA;________
Final
District Local Assistance Engineer (DLAE): ___________________________________
Local Agency:_______________________ Contact:________________ Phone No:_________
Caltrans Oversight Coordinator:_________________________________________________
Environmental Consultant:______________________ Contact:_____________ Phone No:___
Technical Specialist Reviewers: I have performed the required quality control review assigned to me and find that this environmental document
satisfactorily meets State and federal requirements, as applicable, in my area of expertise and is consistent with the applicable technical study.
Reviewer’s Signature
Type of Review
Reviewer (Print Name)
Verification Date
Check the box for each stand-alone technical study prepared for the environmental document;
technical specialist review is only required for each resource topic with a stand-alone technical study.
Biology
_____________________________ ______________________________
__________________
Cultural
_____________________________
______________________________
__________________
CIA
_____________________________ ______________________________
___________________
Visual
_____________________________ ______________________________
___________________
Hazardous Waste
_____________________________
______________________________
___________________
Floodplain
_____________________________
_____________________________
___________________
Water Quality
_____________________________ ______________________________
___________________
Air Quality
_____________________________ ______________________________
__________________
Noise
_____________________________ ______________________________- ___________________
Traffic
_____________________________ ______________________________
__________________
Section 4(f)
_____________________________ ______________________________
___________________
*(check one)
De minimis
Programmatic
Individual
Other:____________ ____________________________
______________________________
___________________
Technical Reviewer:
____________________________
______________________________
___________________
*Signature also required for Section 4(f) de minimis finding.
Required signatures may appear on multiple versions of this form to allow concurrent reviews by specialists and technical editor
I have reviewed this environmental document and find that it is internally consistent and was prepared consistent with the applicable SER
annotated environmental document outline
Environmental Consultant: _____________________ ___________________
Date: _______
Print Name
Signature
I find that the required quality control reviews shown above have been satisfactorily completed and that the environmental document meets all
Caltrans and FHWA requirements
Local Agency: _____________________ ___________________
Date: _______
Print Name
Signature
Date form sent to project file: ________________________
Distribution: 1) District Senior Environmental Planner (for Local Assistance)-Original copy 2) District Local Assistance Engineer-copy
3) Local agency project files
Page 6-123
OB 13-02
March 14, 2013
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