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Form 6 -EHP Review <br />ENVIRONMENTAL and HISTORIC PRESERVATION SCREENING MEMO (EHPSM} <br />This memo should be attached to all project information sent to the Grant Programs Directorate (GPD) for an errvironmental and <br />historic preservation (EHP) regulatory compliance review. Please complete sections A - D of this memo, a.s applicable YYhen <br />questions ar•e not applicable to the project, please leave the field blank This memo is intended to be completed electronically Please <br />contact GPD-EHP for aversion of this memo that is writable for printing and completing by hand <br />A.. PROJECT INFORMATION <br />Grant Program Name: Grant Award Number: <br />Project type (Check all that apply) ^ Physical security enhancements (i e., installation of fencing, carneras, <br />IWIC readers, bollards, motion detection systems, x-ray machines, <br />lighting, etc ) <br /> <br /> <br />Grantee Name: <br />State: County: Agency: <br />Project Title: <br />Fiscal Year: <br />New installation/construction/renovation (i.e ,emergency operations <br />centers, docks, piers, security guard buildings, etc ) <br />Renovations/upgrades/modifications to structures 50 years old or older <br />Communication towers, related equipment, and equipment shelters <br />Other ground disturbing activities (i a ,trenching, excavation, etc. ) <br />Iraining and exercises <br />Purchase of equipment (specify) <br />Other (specify) <br />Subgrantee: <br />B.. PROJECT DESCRYPTION/LOCAIION ('17~e following information will be regzired in order to complete a review for each <br />project type. If multiple `project typei"describe the same project, (i e, physical seczaity enhancements.lND renovations of <br />structures .SO years old or older ~1ND other ground disturbing activifiesJ, ii is not necessaryto repeat information; please make a note <br />to refer back to the previous entry) <br />Project Type: ^ Physical security enhancements (i•,e.., installation of fencing, cameras, TWIC r eaders, <br />bollards, motion detection systems, x-ray machines, lighting, etc..) <br />Project Location (physical project address or latitude/longilude of project location): <br />Color site photos and other visual documentation (i..e , trraps, technical drawings) attached? ^ Yes ^ No <br />Will ground disturbance be required? ^ Yes ^ No <br />If yes, please give total extent (depth, length, and width) <br />Has the ground been previously disturbed? ^ Yes ^ No <br />Please describe previous ground disturbing activities (e.g ,parking lot, farming, commercial development, <br />etc ): <br />Will any equipment or structures need to be installed? ^ Yes ^ No <br />If yes, please explain how and where this is proposed to be done (please include site-specific photographs, and attach <br />additional pages, if needed): <br />Please state the date of construction of the building(s) or structure(s) (e.g., bridge} involved in the proposed project: <br />-~ Page 37 <br />