Owner (s): Operator Operator I.D. Date Field Tract Contract Number (s): Contract Item Number Field Office MANDATORY DOCUMENTATION WITHIN THE PLAN Practice objective, Identification of the extent of practices applied, Location identification, this can be an aerial photo, soils map, reference to the conservation plan map, or a sketch in the plan drawings (legal description is required), Environmental Evaluation NRCS-WA-CPA-052, Documentation of necessary permits federal, state, tribal and local - as applicable, – and Site-specific practice specification The following additional data are needed for the specific practices listed. Use the Check Box to indicate the Requirements are met. Check Requirements COMMENTS Box Certification: For non-NRCS employees: If state license is required to complete this practice then the certifying individual must affix their signature and stamp (i.e.; PE Stamp) to this certification. I have completed a review of all of the practice documentation and certify the applied practice meets NRCS specifications. Certified by: Date: Job Title: JAA LEVEL: _______ (If applicable) Page 1 of 1 July 2017
Owner Operator Contract Number Field Office Operator I.D. Tract Contract Item Number (s): Date Field (s): MANDATORY DOCUMENTATION WITHIN THE PLAN Practice objective, Identification of the extent of practices applied, Location identification, this can be an aerial photo, soils map, reference to the conservation plan map, or a sketch in the plan drawings (legal description is required), Environmental Evaluation NRCS-WA-CPA-052, Documentation of necessary permits – federal, state, tribal and local - as applicable, and Site-specific practice specification The following additional data are needed for the specific practices listed. Check Box Use the Check Box to indicate the Requirements are met. Requirements COMMENTS Certification: For non-NRCS employees: If state license is required to complete this practice then the certifying individual must affix their signature and stamp (i.e.; PE Stamp) to this certification. I have completed a review of all of the practice documentation and certify the applied practice meets NRCS specifications. Certified by: Date: Job Title: JAA LEVEL: _______ (If applicable) Page 1 of 1 July 2017