NEPA Site Conditions and Land Quality

• Document Number:

• Action or Project Title:

• Client / Site:

• Conducted on:

  Date

• Prepared by:

• Location:
  Address

1.0. Date and Time of Site Visit

• Record date and time of site visit.

  Date

2.0. Land Quality

• Will the proposed action involve digging, drilling, scraping, trenching, or another form of soil disturbance?

  Yes

  No

  Unknown

• Describe the nature and level of disturbance.

• Will the action or project cause any damage to native vegetation?

  Yes

  No

• Are there any natural washes or storm water channels within 75 feet of the location of the proposed action?

  Yes

  No

• Will the proposed action disturb one acre or more?

  Yes

  No

• Will erosion or sediments be a concern during storm events?

  Yes

  No

• Will any noise, traffic, or visual aesthetic of the desert region be generated or altered which may affect off-base persons, prosperity, or wildlife?

  Yes

  No

• Has the proposed project area been previously disturbed? If yes, briefly describe level of disturbance.

  Yes

  No

• Is there any evidence of prior soil contamination?

  Yes

  No

3.0. Cultural and Natural Resources

• Will the proposed action take place on or adjacent to an environmentally sensitive area?

  Yes

  No

  Unknown

• Briefly describe area or location.

• Will any known cultural or historical resource be affected at the site of the proposed action?

  Yes

  No

  Unknown

• Briefly describe affected resource.

• Will any known threatened or endangered species (plant or animal) be affected by the proposed action?

  Yes

  No

4.0. Installation Restoration

• Is there an installation restoration site at or near the location of the proposed project?

  Yes

  No

  Unknown

• Provide IR site name.

5.0. Signature Block

• Signature of Person Conducting Site Visit

  Sign