20191562 Ver 1_Eastern Programmatic Mussel Submittal Form B-5664 Sent to Jared on 111918_20191114

Eastern Mussel Programmatic
Project Submittal Form
1.County:
2.Division:
3.Stream name:
4.12-digit HUC:
5.Structure #:
6.WBS # and STIP# (if applicable):
7.Road #:
8.Bridge or culvert?
9.Replacement or repair or rehabilitation or extension?
10.Is bridge or culvert work part of road widening project?
11.Estimated let date:
12.Mussel species adversely affected:
13.Amount of ILF payment - $10,000 or $25,000:
14.Person(s) who made biological conclusion of MA-LAA: