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<br />STATUTORY WORKSHEET <br /> <br />U"" th1s Worksh""t tor proj..ctu which ;.." t:dt"'J()[,c,'lly ¡';xduued. 1"'" >,..ct1011 S8.J5. exc.,!>t [O" <br />minor housing rohabiltt"'i"" projnl'"tn 'h." mnet the l'"r¡t.'rl~ or """tio"s 58,)5(~I!31 (ii, "01' ""coh <br />r<,h~bllit"tio"l'rojcctn. thn w.., of th,' ",.h.,hllitatio" ""v;rUl',,"nt.,1 RO'vl..w anti ^rre",llx ^ r"""o Is <br />r..commcnded, <br /> <br />STATUTES <br /> <br />EXECUTIVE ORDERS <br /> <br />REGULATIONS <br /> <br />R~d;:;~;n;;¡,;c;:;z; if¿: X; 6¡1?¡~?r; :~I : <br /> <br />33D-:J40 j(ed(.{)ú7ld !J-u.i¿>/ <br /> <br /> <br /> <br />Te~~q'!:fth~ ~r~ct are CATF:CORICALLY RXCLUDRD, per Section 58. 35lal or (b). Cite t:he <br />applicable sub"cct:!on of 58.35Ia) or (bl in the space above and complete this Worksheet Isee <br />Instructions on reverse sidel. and then sign and date this form. and retain in the ERR. <br />Write 'A" in the Status Column when the project. by its nature. cannot affect the ruources uod..r <br />consideration. Write "e" when compliance triggers fonnal consultation procedures with oversight <br />agencies. Source docum"ntation must b.. credible. traceable and supportive of the finding made. <br /> <br />CE 5ð,3.bfcp(?)(J.) <br /> <br />COGI1>liance Fact:ors: <br />Statutes. Executive Orders, <br />d R 1 <br /> <br />Status <br /> <br />an egu attons <br />(24 CFR 58.5) AID Supporting Documcntation (SD) <br />Historic Preservation .4 PA ¡:J~. If B ({{(Eð!C(b') <br />Floodplain Management A 2oUf: ß - FßM-1 tafìp #: <br />Wetlands Protection A t= Z- (lJ~c., g.. 2-) <br />Coastal Zone Æ '07 <br />Sole Source Aquifers A co <br />Endanqered Species A C2.. <br />Wild and Scenic Rivers A Cí() <br />Air Quality A 81 <br />Farmland Protection Æ C( <br />Environmental Justice J C (:3 <br />HOD ENVIRONMENTAL STANDARDS I. <br /> C'ç <br /> Noise Abatement and <br /> Control (24 CFR SIB) <br /> Explosive and Flammable ;f At. E 2...- 'DZ¡31'-4-, <br /> Operations (24 CFR SIC) I / <br /> Toxic ChemiCélls/ 8 At.V2.,'3,:-4;EZ. <br /> Radioactive Materials <br /> (HOD Notice 79-33) I S'ee G;(/, I Þ ¡-fs It~ 8 ti C <br /> Airport Clear Zones and A Vé3 <br /> Accident Potential Zones <br /> (24 CFR SID) <br /> <br />Chr.ck <br />( <br /> <br /><x <br /> <br />the hox which ~p"l ieo to '.hi" p' ojC'ct: <br />I The project conv..rts to Ex""'l't. per Section 58.34lall12l. because <br />a violation of any statutes or authoritie., nor requires a permit <br />statute. listed below have the letter 'A' marked in the column). <br />down for this (now) EXEMPT activity. <br />This project cannot convert to Exempt. One or more "tatutes require consultation or <br />mitigation. Complete consultation/mitigation requirements. publish NOI/RROF and <br />complete draw down procedures. per !:ection 58.70 and 58.71. <br />This proj...ct or activity mAy have a si9nificant environmental impact and thus re< \lires <br />preparation of an Environmental ^..e..ment. Compl"'e th" Format I form and applicable <br />public notification. <br /> <br />it will not result in <br />or license (all the <br />Funds may be drawn <br /> <br />/1 ') l <br />PREPARER SIGNATUREl/../;t Oil, A(ijA ~ <br />PRE PARER NAME: l' ' U^- <br />EdU/EJrdfl(j'J1dSC tJ ¡'It <br /> <br />DATE: <br /> <br />711Qlj 7- f! Z-{)T7J <br />