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J. Christopher Ludwig Virginia Department of Conservation and Recreation Division of Natural Heritage 600 E. Main St., 24th Floor Richmond, VA 23219
Species Name (please include a photograph(s) if available): __________________________________ Date Observed: _____________________ County(ies):_____________________________________________________________ USGS Quadrangle Name(s) (if known): ______________________________________________________________ Location: (Provide a detailed description. Include a copy of a USGS topographic map showing the location or sketch a map on the back of this form) Habitat Description: (Include associated species, elevation, natural features, natural community type, etc.) Population Data: (Include data such as number of individuals, age, size, spatial distribution, evidence of reproduction) Property Owner (name, address, phone if known): ____________________________________________________ Threats or evidence of Disturbance: Protection Information: (Under present conditions, will this population maintain itself over a long period of time? Why or why not?) Contact Information: Reported By: _______________________________ Address: Phone: E-Mail: Date:
Habitat Description: (Include associated species, elevation, natural features, natural community type, etc.)
Population Data: (Include data such as number of individuals, age, size, spatial distribution, evidence of reproduction)
Property Owner (name, address, phone if known): ____________________________________________________
Threats or evidence of Disturbance:
Protection Information: (Under present conditions, will this population maintain itself over a long period of time? Why or why not?)
Contact Information: Reported By: _______________________________ Address: Phone: E-Mail: Date:
Address: Phone: E-Mail: Date: