AF-Form-813-Environmental-Impact.pdf

REQUEST FOR ENVIRONMENTAL IMPACT ANALYSIS Report Control Symbol

RCS:

INSTURCTIONS: Section I to be completed by Proponent: Sections II and III to be completed by Environmental Planning Function. Continue on separate sheets as necessary. Reference appropriate item number(s).

SECTION I - PROPONENT INFORMATION

1. TO (Environmental Planning Function)

45 CES/CEV

2. FROM (Proponent organization and functional address symbol)

2a. TELEPHONE NO.

3. TITLE OF PROPOSED ACTION

4. PURPOSE AND NEED FOR ACTION (Identify decisions to be made and need date)

5. DESCRIPTION OF PROPOSED ACTION AND ALTERNATIVES (DOPAA) (Provide sufficient details for evaluation of the total action.)

6. PROPONENT APPROVAL (Name and Grade)

6a. SIGNATURE

6b. DATE

SECTION II - PRELIMINARY ENVIRONMENTAL SURVEY. (Check appropriate box and describe potential environmental effects including cumulative effects.) (+ = positive effect; 0 = no effective; - = adverse effect; U = unknown effect) + 0 - U

7. AIR INSTALLATION COMPATIBLE USE ZONE/LAND USE (Noise, accident potential, encroachment, etc.)

8. AIR QUALITY (Emissions, attainment status, state implementation plan, etc.)

9. WATER RESOURCES (Quality, quantity, source, etc.)

10. SAFETY AND OCCUPATIONAL HEALTH (Asbestos/radiation/chemical exposure, explosives safety quantity-distance, etc.)

11. HAZARDOUS MATERIALS/WASTE (Use/storage/generation, solid waste, etc.)

12. BIOLOGICAL RESOURCES (Wetlands/floodplains, flora, fauna, etc.)

13. CULTURAL RESOURCES (Native American burial sites, archaeological, historical, etc.)

14. GEOLOGY AND SOILS (Topography, minerals, geothermal, Installation Restoration Program, seismicity, etc.)

15. SOCIOECONOMIC (Employment/population projections, school and local fiscal impacts, etc.)

16. OTHER (Potential impacts not addressed above.)

SECTION III - ENVIRONMENTAL ANALYSIS DETERMINATION

17. PROPOSED ACTION QUALIFIES FOR CATAGORICAL EXCLUSION (CATEX) OR

PROPOSED ACTION DOES NOT QUALIFY FOR A CATEX; FURTHER ENVIRONMENTAL ANAYLYSIS IS REQUIRED.

18. REMARKS

19. ENVIRONMENTAL PLANNING FUNCTION CERTIFICATION

(Name and Grade)

19a. SIGNATURE

19b. DATE

AF FORM 813, AUG 93 (EF-V1) (M.S. Word 97 form) THIS FORM CONSOLIDATES AF FORMS 813 AND 814. PAGE 1 OF PAGE(S)

PREVIOUS EDITIONS OF BOTH FORMS ARE OBSOLETE.

AF FORM 813, AUG 93, CONTINUATION SHEET

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