Ex 10_Pre NEPA Questionaire.pdf

Offeror's Signature:

By signing below I acknowledge that I completed this form honestly and to the best of my knowledge.

GSA Region 10 NEPA Pre-Questionnaire

Offeror Company Name:

Development Action Address:

Regulations to consider include but are not limited to: American Indian Religious Freedom Act, Archeological and Historical Preservation Act, Endangered Species Act, National Historic Act, Clean Water Act, Endangered Species Act, Farmlands Protection Act, Flood Disaster Protection Act, Protection of Wetlands, Coastal Zone Management Act, local land use planning and design standards, etc.

Effects to consider are traffic patterns, new roads, land use, occupying tenant, pollution, plant and animal species or habitat, historical or archeological areas, etc.

1) Is this development action likely to be inconsistent with any applicable Federal, State, Indian tribal or local law, regulation or standard designed to protect any aspect of the environment? Yes No Uncertain

2) Is this development action likely to directly or indirectly cause any controversy in the community for social, economic or other environmental concerns? Yes No Uncertain

3) Is this development action likely to adversely affect a significant aspect of the natural or human environment? Yes No Uncertain

4) Does this development project present a high level of uncertainty regarding any of its effects on the natural environment, socioeconomics or human environment? Yes No Uncertain

5) Is this development action part of any other on-going or larger action that may be viewed as inconsistent with regulations, laws and standards or controversial in the community? Yes No Uncertain

6) Is this development action likely to have any other adverse effect on public health or safety or any other environmental aspect that are not specifically identified above? Yes No Uncertain

7) Will any threatened or endangered species be affected by the proposed development action?

Conduct a Fish and Wildlife Review for the proposed development action by completing the US Fish and Wildlife Service Information Planning and Consultation (IPaC) program project planning tool and contacting Oregon Department of Fish and Wildlife (ODFW) Habitat Resources Program for any additional information on threatened and endangered species from local biologists and habitat specialists. Provide documentation from USFWS and ODFW regarding threatened and endangered species and habitats that may be affected. Review the plants, animals and habitats affected and provide a basic evaluation of potential impacts and mitigation measures for those potential impacts. Yes No Uncertain

Provide comments for any questions marked Yes or Uncertain:

Exhibit 10 https://ecos.fws.gov/ipac/ https://ecos.fws.gov/ipac/ http://www.dfw.state.or.us/lands/habitat_resources.asp http://www.dfw.state.or.us/lands/habitat_resources.asp ChelseaLBranchcomb Line