Cambodia - Rural Investment and Local Governance Project (Vol. 4 of 6) : Project information form

E671 vol. 4 November 2002 Project Information Form Province: District: Commune or Sangkat: GIS Code: Name of Project Type of Project Provincial Department responsible Date the Commune or Sangkat Council approved the Development Plan including this project: Date the Provincial or Municipal Governor approved the Development Plan: Objective of Project (as shown in Development Plan) Proposed Outputs of Project Output Description Village Planned Quantity Quantity to be implemented in each year (write in year) In After Developme Design nt Plan Planned Beneficiaries Village Households People Women Children  Attach Project Map - copy of Commune Map Attach Site Plans Attach feasibility study for specific project types Attach Technical Design Attach Cost Estimate Attach Maintenance Plan  Project Information: Report Section Environmental Impact Tick the appropriate answers Is the project a new road construction? Is the project a new irrigation scheme? Is there any other reason why an Environmental Impact Assessment may be needed? Land Ownership and use. Tick the statement (from the following three) that is most true. No land will change from private to public use because of the project. Some land will change from private to public use, but no private land user will lose more than 5% of the land they use. No houses will be moved or destroyed. Some land users will lose more than 5% of their land, or one or more houses will be destroyed.  Site Plan Commune Project Name Date Name of Technical Advisor Village GPS X,Y Is the site flat or sloping? Dry season water level Wet season water level Highest ever flood level Show which way the way the water flows Does the water flow fast, slowly or not at all? Is the soil sand or clay? Is there any rock on the site?