Agency/Project: Oregon Department of Transportation/Project Name ODOT Key Number: :XXXXX, Federal Agency: Agency Name, Federal Aid Number if applicable
Property Name: Click or tap here to enter text.	Street Address: Click or tap here to enter text.
City, County: Click or tap here to enter text.	Latitude: XX.XXXXX Longitude: (-) XXX.XXXXX
Surveyor: Click or tap here to enter text.	Affiliation: Click or tap here to enter text.	Date Recorded: MM/DD/YYYY
Photo: Photo Caption: Property name, facing [direction] (Photographer, MM/YYYY).
Preliminary Finding of Effect: ☐ No Historic Properties Affected ☐ No Historic Properties Adversely Affected ☐ Historic Properties Adversely Affected
State Historic Preservation Office Comments: □ Concur □ Do Not Concur: □ No Historic Properties Affected □ No Historic Properties Adversely Affected □ Historic Properties Adversely Affected Signed: _____________________________________________________ Date: ______________________________ Comments:

Provide written description of the project, and its potential effects on the subject property per 36 CFR 800. The project and findings, as per instructions, should include:

Introduction
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Project Description
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Identification and Description of the Historic Resource
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Undertaking Options Considered
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No-Build Alternative
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Avoidance Alternative
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Proposed Undertaking
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Evaluation of Effects
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Coordination and Public Output
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Conclusion
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Sources
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Maps and Figures

Include aerial or sketch map delineating the property boundary and the locations of all contributing and non-contributing features within the property boundary and maps showing the location of proposed project actions. These can include available engineering drawings or plans, preferably on aerial maps.

Photographs

Provide multiple images of the property that highlight where project actions may be occurring. Depending on the scope and scale of the project, this could include photos of contributing features, non-contributing features, and/or the overall setting of the property. Provide captions under each image with the following format: Property name, facing [direction] (Photographer, YYYY).