(This form may be submited after initial field view, Phase IA Investigation, or Phase I Investigation.)

1. Project Identification:

ER Number

Project Name &/or Agency Tracking #:

Agency: Applicant:

Preparers Name and affiliation:

Date Prepared:

Project Area County/Municipality (list all)

County	Municipality

2. Project Setting: (check all that apply)

urban/suburban; rural

upland; floodplain/terrace (active; stable terrace)

7.5” USGS Quadrangle(s) Name (list all):

Name	Date

Physiographic Zone(s)(list All. Use DCNR Map 13 compiled by W.D. Sevon, Fourth Edition, 2000.):

Physiographic Zone

Project Area Drainage(s), (list all) (Sub-basin and Watershed can be obtained from CRGIS):

Sub-basin	Watershed	Major Stream	Minor Stream

3. Basic Field Conditions:

(Text fields will expand as needed. Please be complete)

Area of APE / Project Area in hectares: Hectares tested:

General Description of APE / Project Area:

Type of Proposed Project / Impact:

Date of field investigation(s):

Description of Field Conditions and Disturbance:

4. Methodology Used to Determine Disturbance: (check all that apply; attach any supporting documents)

PASS file Research	Contacted Local Historical Association/Commission/Park/Etc.

Informant Data	Historic Records/Maps/Photos	SCS Soil Maps

Surface Survey	Geomorphological Borings	STPs

Test Units	Geomorphological Trenches	Remote Sensing

Other:

Professional Geomorphologist was Present or Not Present During Field Investigations

Name:	Affiliation:

Formal Geomorphological Report Prepared: Yes	No

5. Previously Recorded Archaeological Sites within APE / Project Area and not relocated by this project:

PASS Site Number	Particular Disturbance in this area

6. Required Attachments:

7.5’ USGS Quadrangle Map delineating APE / Project Area

APE map showing location of any test units &/or orientation of photographs

At least two (2) supporting photographs with descriptions of view and view direction

Engineering / Project Plans if prepared

Geomorphological Report if prepared

Representative excavation profiles and descriptions

List all other attachments to this Record of Disturbance Form:

Attachment Type