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Report Control Symbol

RCS:

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

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

SAFETY AND OCCUPATIONAL HEALTH (Asbestos/radiation/chemical exposure, explosives safety quantity-distance, bird/wildlife aircraft hazard, etc.)

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

12. BIOLOGICAL RESOURCES (Wetlands/floodplains, threatened or endangered species, 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.)

REQUEST FOR ENVIRONMENTAL IMPACT ANALYSIS

INSTRUCTIONS: 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)

2. FROM (Proponent organization and functional address symbol) 2a. TELEPHONE NO.

3. TITLE OF PROPOSED ACTION

4. PURPOSE AND NEED FOR ACTION (Identify decision 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 U Including cumulative effects.) (+ = positive effect; 0 = no effect; = adverse effect; U= unknown effect)

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

10.

SECTION III - ENVIRONMENTAL ANALYSIS DETERMINATION

17.

PROPOSED ACTION QUALIFIES FOR CATEGORICAL EXCLUSION (CATEX) #

; OR

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

18. REMARKS

19. ENVIRONMENTAL PLANNING FUNCTION CERTIFICATION

19a. SIGNATURE 19b. DATE (Name and Grade)

THIS FORM CONSOLIDATES AF FORMS 813 AND 814.

PREVIOUS EDITIONS OF BOTH FORMS ARE OBSOLETE.

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AF IMT 813, 19990901, V1

AF IMT 813, SEP 99, CONTINUATION SHEET

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