ࡱ> % O.bjbj%% GG<)l z#$#5$$($$$%%%4444444$5 7r4%%%%%4'$$4'''%$$4'%4'"' *+hg,$$ 0SrF %G,g,,405W,\8'\8g,'t<:UNDERTAKING LOCATION AND NAMEDistrictCountyRouteKilo Post(s)(Post Mile(s)Charge UnitExpenditure Authorization Project Name: This checklist is designed to assist Caltrans staff in following appropriate procedures for 36 CFR 800 compliance for Categorical Exclusion (CE) projects, and CEQA compliance for Categorical Exemption (CE) projects. An appropriately qualified Caltrans cultural resources staff as outlined in PA Attachment 1, Caltrans Professionally Qualified Staff Standards, must complete the checklist. Start with Task 1, indicate Yes or No, as applicable, and follow the go to instructions. When completed, this form, with supporting documentation attached, serves as a Memo to File in the District CE file.1. Does this project qualify as a screened undertaking as described in PA Attachment 2, Screened Undertakings? YES. Go to 11.NO. Go to 2. 2. Is a BRIDGE located within the project postmiles? If not, go to 3; if so, consult the Caltrans Historic Highway Bridge Inventory. If the bridge is a:  __Category 1 or 2 bridge, go to 12. For state-only projects go to 13._ Category 3, 4 or 5 bridge built before 1960; contact the Section 106/PA Coordination Branch Chief in the DEA Cultural & Community Studies Office in Headquarters for further guidance. If the bridge requires re-evaluation, go to 12. For state-only projects go to 13. If re-evaluation is not required, print the appropriate page of the bridge inventory, and go to 12, for state-only projects go to 13. __Category 5 bridge built after 1959, print the appropriate page of the bridge inventory, and go to 3. 3. Review literature/records to determine potential for involvement of cultural resources. Consult the:  National Register of Historic Places and Updates:NegativePositiveCalifornia Register of Historical Resources:NegativePositiveCalifornia Historical Landmarks (State of California 1990):NegativePositiveCalifornia Inventory of Historical Resources (State of California 1976):NegativePositive Also consult district records, maps, as-builts, databases, local historic resource inventories, and collective corporate memory for information about cultural sensitivity and extent of modern development and ground disturbance in the project area. In general, any project that will disturb ground previously undisturbed by road construction may require a field review to determine if surveys are necessary.  __ If the records review indicates the presence of cultural resources or if there is too little information to make a decision as to the type of studies needed, perform a field review and further assess the need for studies. To examine the potential for archaeological sites, architectural properties, and other built environment resources within the project area, go to 4.__If the records review indicates no possibility of cultural resources being present and the project involves no ground-disturbing activities, then state the explicit reasons why a survey is unnecessary, attach statement to this checklist, and go to 11 4. ARCHAEOLOGY: Examine the project area for terrain already subjected to massive modern disturbance (e.g., cuts, fill, pavement, built environment). Projects that disturb natural soil may affect archaeological deposits, artifacts, or other prehistoric or historic materials. Note that the integrity of archaeological materials is not the issue, just their potential presence. If the project:  __will not affect natural soils, or the areas to be disturbed are sufficiently altered to preclude any suggestion of archaeological materials being present (e.g., project takes place entirely on fill or in a cut below natural soil horizons), an archaeological survey is not warranted. State the explicit reasons why a survey is unnecessary, attach statement to this checklist, and go to 7. __will affect natural soils, or archaeological materials may be present; an archaeological survey is warranted. Go to 5. 5. Prepare maps and request a records search at the appropriate Information Center of the California Historical Resources Information System. If the record search indicates that the APE:   __has been surveyed, examine the survey report(s). If the report does not meet Caltrans standards, go to 6. If it does meet Caltrans standards and is negative, go to 7; if the survey is positive, go to 12, for state-only projects go to 13.__has not been surveyed, go to 6. 6. Conduct an archaeological survey.  __Prepare an ASR discussing survey results, including discussion of Properties Exempt from Evaluation as appropriate, and go to 7. 7. ARCHITECTURE: Examine the project area for architectural properties that may be directly or indirectly affected by the project. Note: If there is any question as to whether an architectural property may be directly or indirectly affected, contact the district architectural historian(s) or the DEA Section 106/PA Coordination Branch Chief. If the:  __project study area contains buildings, structures or objects that could be directly or indirectly affected by the project (including associated landscaping/setting), an architectural survey/evaluation is warranted, go to 8.__ project study area does not contain buildings, structures or objects that could be directly or indirectly affected, an architectural survey/evaluation is not warranted; go to 9. 8. Have qualified Caltrans architectural history staff who meet the qualifications outlined in PA Attachment 1 evaluate the buildings, structures or objects.  __If staff determines that the properties do not fall within the purview of PA Attachment 4, Properties Exempt from Evaluation, go to 12, for state-only projects go to 13. __If staff determine that all the properties qualify for treatment under PA Attachment 4, Properties Exempt from Evaluation, attach a statement documenting this finding or document it in the HPSR findings check box, and go to 10. 9. Examine the project area for other BUILT ENVIRONMENT RESOURCES (e.g., mines, roads, canals) that could be potentially significant or may contribute to the significance of a larger historic property. If the project:  __may directly affect potentially significant built environment resources, a historical evaluation is warranted; go to 12, for state-only projects go to 13. __may not directly affect potentially significant built environment resources, a historical evaluation is not warranted; go to 10. 10. Examine the results of the field reviews/surveys. If cultural resources surveys resulted in:  __a statement justifying why an archaeological survey was unnecessary, a ASR that resulted in no sites identified, a statement that all properties fall under PA Attachment 4, or a Category 5 bridge evaluation sheet, prepare an HPSR with Findings to File and attach it to this checklist, place in CE file, and go to 11. __an ASR that identified sites, architectural properties requiring evaluation, Category 1-4 bridges, Category 5 bridges that have turned 50 years old since last evaluated, or any previously unidentified resources determined potentially significant, prepare an HPSR with Findings to SHPO and go to 12; for state-only projects go to 13. 11. Present CE Determination Form to FHWA Transportation Engineer for Signature. (Note: If a Programmatic CE, only District Environmental Branch Chief signature is necessary). For projects screened in accordance with Section 106 PA Attachment 2, the completed and signed CE Checklist serves as the Memo to File. For projects that do not meet the criteria for screened undertakings in Section 106 PA Attachment 2 and where Caltrans archaeological or architectural study findings are negative, prepare an HPSR with Findings to File. The FHWA Transportation Engineer will review the CE file and confirm the study results, as evidenced by the signing of the CE Determination Form that shows No adjacent to NEPA question number 1. Section 106 complete. For state-only projects: CEQA and PRC 5024 compliance for cultural resources is complete.12. Prepare the APE map and obtain Caltrans PQS signatures as appropriate. Conduct all necessary archaeological or architectural studies. Prepare and process an HPSR with Findings to SHPO to SHPO and FHWA requesting concurrence on eligibility and effect as appropriate. The FHWA Transportation Engineer will sign the CE Determination Form once the requirements of 36 CFR 800 have been satisfied, as evidenced by a letter from SHPO to FHWA. Attach the Section 106 compliance letter to the CE. Section 106 complete. Go to 14.13. For state-only projects. Prepare the Project Area map and obtain Caltrans PQS signatures as appropriate. Conduct all necessary archaeological or architectural studies. Prepare a positive HRCR. Go to 14. 14. Are there state-owned buildings or structures in the Project Area that are listed in/eligible for listing in the National Register or registered/eligible for registration as California Historical Landmark(s)? __YES. Submit the HRCR to SHPO, per PRC 5024, requesting concurrence on eligibility and no effect/no adverse effect as appropriate. Attach a copy of SHPOs concurrence letter to the CE determination form. Go to 15. __NO. Go to 15. 15. Is there a substantial adverse change to a historical resource under CEQA? __YES. The project does not qualify as a CEQA C.E. Prepare the appropriate CEQA documentation (Negative Declaration or EIR). __NO. Go to 16. 16. Federal undertakings: The FHWA Transportation Engineers signature or District Environmental Branch Chiefs signature on the CE Determination Form, as described in Step 11, concurrently signifies there is no substantial adverse change to historical resources, the requirements for CEQA have been met, and for state-owned resources PRC 5024 requirements have been met. PRC 5024 and CEQA compliance for cultural resources is complete. State-only projects: The DEBC will sign CE Determination Form indicating that CEQA cultural resources requirements have been met, that the project qualifies as a C.E., and for state-owned resources PRC 5024 requirements have been met. PRC 5024 and CEQA compliance for cultural resources is complete.  Prepared by:District(Type Name here)(Sign on line below) PQS discipline/level:[Date](Add the level at which preparer is certified on line above)Comments: (Add explanatory comments below) California Department of Transportation Categorical Exclusion/EXEMPTION (CE) Cultural Resources Checklist PA Attachment = Attachments to the Section 106 Programmatic Agreement; see Environmental Handbook vol. 2 [CE-ChecklistRev: 4/05] Page  PAGE 1 of  NUMPAGES 4 !"noncfiuvxz"#$&)nt o p q ,-.2,-./0@Ev~DEFGKCJ\5CJ >*CJ\6CJ]>*CJCJ5 5\]>*]] 56CJ\6CJ>*NH;CJ 5;CJK(/5BP\v`7$$IfTl4p%%4 la$If <-N.vwxyz{|}~WSKKKKKK$If$$IfTl֞* j%H 4 la~O $$IfTlC֞* j%H 4 la$If@aJ$$IfTl4C04%[ 4 la$IfJ$$IfTl4C04%[ 4 labcdefu $$Ifa$$a$$If$If <$If<7$$IfTl4C%%4 la uvwx@0`$$IfTl4@Fb%h  "    4 la$If $$Ifa$`$$IfTl4@Fb%h "    4 la"#$%&)m~uum($If $$Ifa$$a$:$$IfTl4C%%4 la:$$IfTl4C%%4 la$If mnoqrst   n o p \ h$If($If $$Ifa$`$$IfTl4CF%j"    4 la p q r     # $If $$Ifa$ & F$If & F h$If h:$$IfTl4C%%4 la # $ Q R [ \ e yof`f`$If $$Ifa$ & F$If$$IfTl4CrL 9%\ l V4 lae f  yDof`f`yxof`f$If $$Ifa$ & F$If$$IfTl4CrL 9%\  l  V4 la     sk1:$$IfTl4C%%4 la$If$$IfTl4CrL 9%\  l  V4 la$If  -r  ($If$  $Ifa$ $  a$:$$IfTl4C%%4 la$If hh$If^h` hh^h` -./2-./0|B:$$IfTl4C%%4 la$If  ($If$  $Ifa$`$$IfTl4CF%j"    4 la01E($If $$Ifa$$a$:$$IfTl4C%%4 la$IfEFGHK($If $$Ifa$`$$IfTl4@Ff%)#    4 laKPxy|PVc8<QSTW!'opqv~EGIJ w#####%%565CJ]>*CJCJ]5CJ6[_]_XO $$Ifa$$a$:$$IfTl4C%%4 la$If`$$IfTl4@Ff%)#    4 la wxy|`$$IfTl4@F%"    4 la($If $$Ifa$]UII] h$If h:$$IfTl4C%%4 la$If`$$IfTl4@F%"    4 laOPQRS\:$$IfTl4C%%4 la$IfM$$IfTl4C0%,"4 la$If $$Ifa$$a$ PQbbM$$IfTl4J0%,"4 la($If $$Ifa$$a$:$$IfTl4C%%4 la QRST$If $$Ifa$$a$:$$IfTl4C%%4 la h$If h op_t:$$IfTl4C%%4 la$Ifx$If $$Ifa$M$$IfTl4J0%,"4 la pqrsvbbM$$IfTl4J0%,"4 la($If $$Ifa$$a$:$$IfTl4C%%4 la D($If $$Ifa$$a$:$$IfTl4C%%4 la $ h$Ifa$$ ha$ DEFGJ #T_0 :$$IfTl4C%%4 la$If($If $$Ifa$M$$IfTl4J0%,"4 la ####%%%%&&&&''''(@DX $$Ifa$$a$ hh$If^h`$If$If:$$IfTl4C%%4 la%%%%%&&&&&&''''((((((((((((f)g)h)k)m)y)z)|)}))))*+3+5+H+!,/,b,c,d,e,f,g,u,,,,,,,,,,,- - --4-5-6-7-8-9-;-<----.\5CJ 5;CJ>*CJNH6]CJ>*56 56\]CJ] 5\]>*]CJ]]N(((((((((((H]@]X$a$:$$IfTl4C%%4 la$If$If $$Ifa$M$$IfTl4C0%u"4 la ((g)h)k)y)z){)|)})4+H] :$$IfTl4C%%4 la$IfM$$IfTl4D0%u"4 la$If $$Ifa$ 4+d,e,f,g,h,u,~,,, $$Ifa$$If:$$IfTl4C%%4 la$If ,,,,,,d $$Ifa$s$$IfTl4C\40 %w _4 la,,,,,, $$Ifa$`$$IfTl4CF=%u     4 la,,-- -zz $$Ifa$ $$Ifa$s$$IfTl4C\=%% u 4 la - -5-6-7-8-9-:-OOFO $$Ifa$:$$IfTl4C%%4 la$ 8 $If^a$`$$IfTl4CF=%u     4 la:-;-<-e----.L.M.N.O.  !V$dN]V$ (#&dPa$ $ (#a$ 8 d^$a$ .(./.0.6.7.8.9.=.>.H.I.J.K.L.N.O.CJ0J\mHnHu0J\j0JU\\CJ\/ =!"8#$%" 00/ =!"8#$% 0/ =!"8#$%" 00/ =!"8#$% 0/ =!"8#$%" 00/ =!"8#$% 0/ =!"8#$%" 00/ =!"8#$% 0/ =!"8#$%" 00/ =!"8#$% 0/ =!"8#$%" 00/ =!"8#$% 0/ =!"8#$%" 00/ =!"8#$% 0/ =!"8#$%" 00/ =!"8#$% 0/ =!"8#$%" 00/ =!"8#$% 0/ =!"8#$%" 00/ =!"8#$% 0/ =!"8#$%" 00/ =!"8#$% 0/ =!"8#$%" 00/ =!"8#$% 0/ =!"8#$%" 00/ =!"8#$% 0/ =!"8#$%" 00/ =!"8#$% 0/ =!"8#$%" 00/ =!"8#$% i0@0 Normal_HmH sH tH 0@0 Heading 1$@&CJF@F Heading 2$<@&56CJOJQJ<A@< Default Paragraph Font*B@* Body TextCJHC@H Body Text Indent ^CJNR@N Body Text Indent 2 8@@h^hJS@"J Body Text Indent 3$^a$CJ,@2, Header  !, @B, Footer  !&)@Q& Page NumberzO!zExhibit Heading 12% Ppx@&^p`6;CJ OJQJmHnHudOd CE Checklist Hanging 1 hh^h`CJ]xd%r 1 QRr#$${%h(O*Bc̰2Vw%Fjв9Z~ó#zzzzxd%r 1 QRr"#$${%h(O*(/5BP\vwxyz{|}~bcdefuvwx"#$%&)mnoqrst nopqr#$QR[\ef   - . / 2 - . / 0 1 EFGHKwxy|OPQRSPQRSTopqrsvDEFGJ!!!!""""####$$$$$$$$$$$$g%h%k%y%z%{%|%}%4'd(e(f(g(h(u(~(((((((((((((()) ) )5)6)7)8)9):);)<)e))))*L*M*P*00@0@0@0@0@0@0@0@0`000000000@0@0@0@00@000`0000@0@0@0@0`00000@00@0@0@0@0`0000`000000000000000000`0000`0 000000 000000 000000 000000000000000000000000`0000`000000000000`0000`000000000000`0000`00000`000000`000000000`000000`000000000`000000`000000000`000000`00000000000`00000000000@0@0@0@0@0@0`0000@0@0@0`000@0@0`0000@0@0@0`000@0@0@0@0@0`000000@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@000000000llK%.O.0BNWv~ump # e  -0EQpD#((4+,,, -:-O.13456789:;<=>?@ACDEFGHIJKLMOPQRSTUVN.2O* !8@0(  B S  ?<)P*wxyyzz{{||}}~~cdeeww$%&(ooqr 0 1 PQQRqr!!##$$$$z%{%g(h(<)P*gscottcC:\Documents and Settings\gscott\Application Data\Microsoft\Word\AutoRecovery save of Document1.asdgscottC:\Documents and Settings\gscott\My Documents\Personal\Word\GUIDANCE\EHHandbook\EH 2005 Revisions\EH 2005 Templates\Section_106_CE_Checklist-rev-Apr-05.dot5Z, npiB8[6ANw   h^ `OJQJo(hh^h`o(.  H^ `HOJQJo(hh^h`CJ. hh^h`OJQJo([NwZ,npiB5(/5BP\vwxyz{|}~bcdefuvwx#$%&)mnot nopqr#$QR[\ef   - . / 2 - . / 0 1 EFGKwxy|OPQRSPQRSTpqrvDEJ!!!!""""####$$$$$$$$$$$$g%h%k%y%z%{%|%}%d(e(f(g(h(u(~((((((((((((()) ) )5)6)7)8)9):)<)M*P*@xxxx@{O*`@UnknownGz Times New Roman5Symbol3& z Arial"hc7RX!?#KL20d+2QSECTION 106/CE ChecklistgscottgscottOh+'0 ,8 T ` l xSECTION 106/CE Checklist0ECTgscott sco0Section 106 CE Checklist -Feb 03-04 version.dotgscott 1coMicrosoft Word 9.0k@,@^ϴ!@F@`XF?#՜.+,0 hp   Caltrans0K+ SECTION 106/CE Checklist Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ\]^_`abcdefghijklmnopqrstuvwyz{|}~Root Entry FpiorF1Table[\8WordDocumentSummaryInformation(xDocumentSummaryInformation8CompObjjObjectPoolpiorFpiorF  FMicrosoft Word Document MSWordDocWord.Document.89q