+----------------------------+-----------------------------------------+
| U.S. Department of         | **dasfs**                               |
| Agriculture                |                                         |
|                            | **SPACE REQUIREMENTS QUESTIONNAIRE**    |
| Marketing and Regulatory   |                                         |
| Programs                   |                                         |
|                            |                                         |
| Agricultural Marketing     |                                         |
| Service                    |                                         |
|                            |                                         |
| Animal and Plant Health    |                                         |
| Inspection Service         |                                         |
|                            |                                         |
| Grain Inspection, Packers  |                                         |
| and Stockyards             |                                         |
| Administration             |                                         |
+----------------------------+-----------------------------------------+

Agency-     

Date-     

Briefly describe the responsibilities/mission of your work unit-     

Delineated Area-     

North-     

South-     

East-     

West-     

Delineated area is that portion of a city, county or state your space
needs to be within in order to serve your customers. A map of the area
with the delineated area highlighted is beneficial. First consideration
should be in rural areas. (Rural Development Act of 1972) If located in
urban area, you must include the Central Business District (CBD) or
provide a justification for being outside the CBD. (EO127072)

Date required (if other than a continuing requirement)-     

Estimated term of lease- 3 years 5 years 10 years      years

Termination rights after-     years

Hours of normal operation -- Weekdays-     

Weekends-     

What other times do you anticipate needing access to the space?     

Normally, you will have 24 hour access to your space, but heating,
ventilating, and air conditioning (HVAC), electrical service, and
perhaps even elevator service may not be available in excess of 11 hours
per weekday unless additional payment/arrangement is made.

Do you want janitorial services included in the lease? Yes No

When should janitorial services be performed? During the day After
normal hours

After hours cleaning is, in some cases, more expensive and would
therefore require additional funding.

Do you have equipment such as power files, a safe, **large** copy
machines, central file rooms or libraries, which may require additional
floor load requirements? Yes No

If yes, list equipment size and weight, if known-     

What agencies, if any, should you be located near-     

What agencies, if any, should you not be located near-     

Will interior columns cause a problem? Yes No

Can the space be divided between floors or by a common hallway? Yes No

Does the space need to be on a particular floor? Yes No Which
floor?     

Explain-     

How many full-time employees of each gender do you have located on site
(for use in determining number of rest rooms needed)? Males      Females
     

Manufacture of current phone system-     

Lenel System (APHIS offices only) will be used? Yes No

Additional security requirements-     

Do you require a backup generator (hook-up)? Yes No

[Departmental Regulation
1620-2](http://www.ocio.usda.gov/directives/doc/DR1620-002.htm), dated
May 17, 2004, "USDA Space Management Policy", provides for the
following:

> "Field offices will be designed utilizing an open space concept with
> minimal architectural barriers between agencies. Private offices
> should be kept to a minimum. To the greatest extent possible, modular
> or systems furniture should be used to accommodate workflow and
> employee privacy."

**The Utilization Rate (UR) [will not exceed 150 square feet per
person]{.underline}.** Generally this will include all space finished as
standard office space. Types of space included in the Utilization Rate
are: employee workstations (including shared workstations), reception
area, office file space, consultation rooms, all private offices, mail
room, and copy room.

Types of space **not** included in the Utilization Rate are:
conference/training room, laboratory, light industrial, warehouse, ware
yard, nursing mothers' room, sick room, break room, kennels, storage,
formal computer/server room, specialty space, circulation space, and
parking.

***Note: The Realty Specialist will calculate the total amount of space
requested, excluding warehouse and ware yard, and add 15% to 20% to
allow for circulation space.***

*Calculate: \# of employees*       *X 150 sq. ft. =*      *sq. ft.*

*Calculate: \# of part time/**seasonal employees*      *X 60 sq. ft. =*
     *sq. ft.*

List all the PRIVATE offices/rooms needed:

+------------------+-----+------+-------+-------+--------------------+
| Room Type        | \#  | SF/  | Total | Part  | Comments/Notes     |
|                  | of  | Room | SF    | of UR |                    |
|                  | Ro  |      |       |       |                    |
|                  | oms |      |       |       |                    |
+------------------+-----+------+-------+-------+--------------------+
| Private Office   |     |      |       | Yes   |                    |
| (list below)     |     |      |       |       |                    |
+------------------+-----+------+-------+-------+--------------------+
|                  |     |      |       |       | **     **          |
|                  |     |      |       |       |                    |
+------------------+-----+------+-------+-------+--------------------+
|                  |     |      |       |       | **     **          |
|                  |     |      |       |       |                    |
+------------------+-----+------+-------+-------+--------------------+
|                  |     |      |       |       | **     **          |
|                  |     |      |       |       |                    |
+------------------+-----+------+-------+-------+--------------------+
|                  |     |      |       |       | **     **          |
|                  |     |      |       |       |                    |
+------------------+-----+------+-------+-------+--------------------+
| Employee Work    |     |      |       | Yes   | **     **          |
| Stations         |     |      |       |       |                    |
|                  |     |      |       |       |                    |
| (system          |     |      |       |       |                    |
| furniture)       |     |      |       |       |                    |
+------------------+-----+------+-------+-------+--------------------+
| Reception Area   | **  | *    | **    | Yes   | **     **          |
|                  |     | *    |    ** |       |                    |
|                  |  ** |   ** |       |       |                    |
+------------------+-----+------+-------+-------+--------------------+
| Copy Room/Mail   |     |      |       | Yes   | **     **          |
| Room             |     |      |       |       |                    |
+------------------+-----+------+-------+-------+--------------------+
| Con              |     |      |       | No    | **     **          |
| ference/Training |     |      |       |       |                    |
| Room             |     |      |       |       |                    |
+------------------+-----+------+-------+-------+--------------------+
| Sick             |     |      |       | No    | **     **          |
| Room/Nursing     |     |      |       |       |                    |
| Mothers'         |     |      |       |       |                    |
+------------------+-----+------+-------+-------+--------------------+
| Break Room       |     |      |       | No    | **     **          |
|                  |     |      |       |       |                    |
+------------------+-----+------+-------+-------+--------------------+
| Laboratory Space |     |      |       | No    | **     **          |
|                  |     |      |       |       |                    |
+------------------+-----+------+-------+-------+--------------------+
| Server Room      |     |      |       | No    | **     **          |
|                  |     |      |       |       |                    |
+------------------+-----+------+-------+-------+--------------------+
| General Storage  |     |      |       | No    | **     **          |
| Space            |     |      |       |       |                    |
+------------------+-----+------+-------+-------+--------------------+
| Light Industrial |     |      |       | No    | **     **          |
| Space            |     |      |       |       |                    |
+------------------+-----+------+-------+-------+--------------------+
| Warehouse Space  |     |      |       | No    |                    |
+------------------+-----+------+-------+-------+--------------------+
| Ware Yard        |     |      |       | No    | **     **          |
+------------------+-----+------+-------+-------+--------------------+
| **Specialty      |     |      |       | *     | **     **          |
| Space**          |     |      |       | *No** |                    |
+------------------+-----+------+-------+-------+--------------------+

**Comments-     **

Please complete expanded questionnaire for each room type checked above.
Only print and forward pages that apply.

**[OFFICE SPACE]{.underline}**

Office space is designed to provide an acceptable environment which is
suitable for standard office operations and includes adequate lighting,
heating ventilation and air conditioning (HVAC), floor covering,
finished walls, window dressings and accessibility. Office space may
consist of a large open area (preferred) or be partitioned into rooms.
Corridors and closets created within the office space are classified as
office space.

*Total amount of office space required-*      *sq. ft.*

Number of workstations-      Systems furniture: Yes No

The following special requirements may be considered above standard and
may require a lump-sum payment. Please check if required and explain if
necessary.

Decorative lights, spotlights or lighting levels in excess of 50 foot
candles at desk height      

Observation windows and sidelight glass panels in private offices      

Glass doors or double doors except for central reception areas or doors
leading to large supply areas      

Digital security locks (Cypher lock)      

Interior office door locks      

Ceilings higher than 8.5 feet: Where-     

Walls and ceilings with noise ratings greater than NIC 35 or sound
masking systems      

Special security partitioning (slab-to-slab, wire mesh)      

Folding partition/accordion door      

Coat closet      

Dedicated electric outlets      

Specifics-     

**[CONFERENCE/TRAINING ROOM]{.underline}**

This is space used for training or hearings and includes supplemental
HVAC and/or built-in special equipment such as blackout drapes, lighting
controls, mounted projection equipment, and acoustical treatment.

*Total amount of conference/training space required-*      *sq. ft.
(Average attendance equals 20 sq. ft. per person)*

The following special requirements may be considered above standard and
may require a lump-sum payment. Please check if required and explain if
necessary. Indicate if any of the items are Agency owned.

Separate HVAC zone controls in order to maintain adequate ventilation
and temperatures when occupied by     

persons      

Installation of mounted whiteboards, projection screens, projectors, TV
mounts, speakers,

computer/sound equipment racks, sound systems      

Blackout drapes      

Telephone service      

Computer service      

Acoustical wall treatment      

45 STC for walls      

55 STC for ceilings      

Special lighting (track, indirect, recessed)      

Dimmer switch      

Folding partition/accordion door      

Equipment/furniture storage closet      

Floor outlets      

Specifics-     

**[SICK ROOM/NURSING MOTHER]{.underline}**

This space is designed for the physical welfare of employees.

*Total amount of sick room/nursing mother space required-      sq. ft.*

The following special requirements may be considered above standard and
may require a lump-sum payment. Please check if required and explain if
necessary.

Door lock      

Counter/Cabinets (describe length, width, material, etc.)      Upper
cabinets Lower cabinets      

Electrical outlet      

Small refrigerator (Agency provided)      

Stationary or portable breast pump (contact your Work, Life, Wellness
representative for information on getting equipment)      

Couch Recliner Side Table

Specifics-     

**[BREAK ROOM]{.underline}**

This space is devoted to the preparation and dispensing of food and or
vending.

*Total amount of break room space required-*      *sq. ft.*

The following special requirements may be considered above standard and
may require a lump-sum payment. Please check if required and explain if
necessary.

Tile or vinyl floor      

Plumbing consistent with use: Drain size-     

Kitchen sink with base cabinet      

Garbage disposal: Horsepower-     

Exhaust fan      

Counter/Cabinets (describe length, width, material, etc.)       Upper
cabinets Lower cabinets      

Electrical outlets      

Microwave Refrigerator Coffee maker Stove

Specifics-     

**[LABORATORY SPACE]{.underline}**

This space includes built-in equipment and utilities required for
qualitative and quantitative analysis of matter, experimentation, and
the processing of materials.

*Total amount of laboratory space required-*      *sq. ft.*

Describe type of work that will be performed in this area-     

Flammable or hazardous storage Yes No

If yes, describe materials and quantities to be stored:

  ----------------------- ----------------------- -----------------------------------------------
  [Name of                [Quantity of            [Special storage requirements]{.underline}
  material]{.underline}   material]{.underline}   

                                                       

                                                       

                                                       
  ----------------------- ----------------------- -----------------------------------------------

*Comments-     *

Volumes of chemicals flushed down the drains on a weekly basis:

  ------------------------- ------------------- ---------------------------------------------
  [Chemicals]{.underline}   [Gallons per        [Special storage requirements]{.underline}
                            week]{.underline}   

                                                     

                                                     

                                                     
  ------------------------- ------------------- ---------------------------------------------

Comments-     

The following special requirements may be considered above standard and
may require a lump-sum payment. Please check if required and explain if
necessary.

Special floors such as quarry tile, gratings, epoxy or chemical
resistant      

Special color for floor      

Special wall, grid or ceiling colors and/or matte finish      

Special lighting      

Special plumbing: Drain size-     

Floor drains with sediment trap and sump: Drain size-     

Stainless steel sink Double Single      

Hot and cold water

Spray nozzle In sink Industrial

Garbage disposal: Horsepower-     

Special HVAC to treat and exhaust noxious or otherwise offensive gases,
higher levels of fresh air (up to 100 percent fresh air), and

special temperature control (up to +/- 2 degrees)      

Negative air pressure      

Fume hood: Size-     or Exhaust fan with screen: Speed-     c.f.m.
vented or not vented to the outside      

Emergency showers (tepid water approximately 70 degrees)      

Eyewash station (tepid water approximately 70 degrees)      

Shower/Locker Room

Number of showers      

Number of lockers      

Unisex restroom      

Counter (describe length, width, height, material, etc.)      

Backsplash: Height-     

Microscope drop down (29") counter      

Cabinets (describe length, width, height, material, etc.)       Upper
cabinets Lower cabinets      

Steamer sterilizer Outdoor Indoor      

Telephone service      

Computer service      

Specifics-     

**[SERVER ROOM]{.underline}**

This space is used for housing computer equipment and includes special
features such as humidity and temperature control, raised flooring and
extensive power requirements. Walls and ceiling will have a noise
reduction coefficient of 0.65 or better. Acoustical tile fastened to the
surface will normally provide the required noise reduction.

*Total amount of server room space required-      sq. ft.*

The following special requirements may be considered above standard and
may require a lump-sum payment. Please check if required and explain if
necessary.

Raised floor: Height-     

Under-floor cooling system      

Floor drain      

STC \>40, for walls and ceilings      

Anti-static carpet is required      

HVAC capable of maintaining an operating environment for the computer
equipment which is compatible

with manufacturer\'s recommendation      

\- Temperature will be maintained in a range from a minimum of       to
a maximum of      degrees F.

\- A humidity range will be maintained in a range from       to      
percent.

\- Temperatures and humidity ranges will be maintained       hours a
day,      days a week.

Separate, dedicated electrical panel controlling equipment within the
room      

Special electrical      

Isolation transformers      

Emergency shutdown control switches. An emergency shutdown control needs
to be installed to provide

> manual control over the equipment power and the air conditioning      

Emergency power supply      

Portable power center      

Uninterrupted Power Supply (A power source from a constant,
self-contained source that is not affected by commercial

> power failures or fluctuations. Power is switched over and supplied
> for at least sufficient time for an orderly shut down to prevent data
> loss)      

Convenience-type electrical outlets for test equipment: How many-     

Telephone outlet or special telephone line: How many-     

Cable runs to remote terminals: Number of Personal Computers-     

Audible and visual alarms      

Dead bolt lock      

Push-button combination lock on entry door      

Window in door      

Local Area Network (LAN) Closet      

> Local Area Network (The connecting or clustering of several computer
> terminals by means of data cable for the purpose
>
> Of accessing multiple storage disk drives, printers, etc. among a
> group of users in a local area      

Wide Area Network (Systems/data circuits which provide or accept data
intrastate/interstate      

Satellite/Radio      

Wet pipe sprinkler protection      

Supplemental Halon fire suppression system      

Dry sprinkler protection      

Specifics-     

**[GENERAL STORAGE SPACE]{.underline}**

General storage space generally has concrete, woodblock, or unfinished
floors, and unfinished walls and can include attics, basements, sheds
and unimproved areas of office buildings. As its name implies, it is
used for the storage of supplies, equipment, records and materials.
General storage space may have HVAC at a minimum of 55 degrees
Fahrenheit and lighting level of 10 foot candles at floor level and is
generally contiguous or adjacent to office or special purpose space.
**Flammable and hazardous material should not be stored in this space.**

*Total amount of general storage space required-*      *sq. ft.*

The following special requirements may be considered above standard and
may require a lump-sum payment. Please check if required and explain if
necessary.

Door lock      

Special security partitioning (slab-to-slab, wire mesh)      

Lighting in excess of 10 foot candles      

Special fire protection features      

Floor load capacity exceeding 100 lb/sq. ft.     

Exhaust fan      

Specifics-     

**[LIGHT INDUSTRIAL SPACE]{.underline}**

This space shares some or all of the characteristics of warehouse space,
but differs with the inclusion of one or more of the following features:
HVAC, humidity control, special power, and a light level equal to or
slightly less than office space. Examples are: product classifying
laboratories, locker rooms, work shops, canopy areas, loading docks and
shipping platforms.

*Total amount of light industrial space required-*     *sq. ft.*

Describe how the space will be used-     

Flammable or hazardous storage Yes No

If yes, describe materials and quantities to be stored:

  ----------------------- ----------------------- -----------------------------------------------
  [Name of                [Quantity of            [Special storage requirements]{.underline}
  material]{.underline}   material]{.underline}   

                                                       

                                                       

                                                       
  ----------------------- ----------------------- -----------------------------------------------

*Comments-     *

The following special requirements may be considered above standard and
may require a lump-sum payment. Please check if required and explain if
necessary.

HVAC equivalent to office space      

Minimum ceiling height-     

110V, dedicated electrical outlets      

Special electrical service (220V, 30Amp Standard: 30Amp 50Amp)      

Lighting in excess of 20 foot candles      

Floor load capacity exceeding 200 lb/sq. ft.      

Tile or other finished floors (more then sealed concrete)      

Floor drains with sediment trap and sump - Drain size:      

Hose bib Inside Outside      

Laundry sink with hot water      

Mop sink with hot water

Shelving      

Special fire protection features      

Automatic fire sprinkler      

Fire hydrant or standpipe      

Air curtain      

Plastic weather curtain      

Loading dock

> \- Size of trucks that will be accommodated-     
>
> \- Turning radius-     
>
> \- Dock height-     
>
> \- Dock must be enclosed/covered Yes No      
>
> \- Dock freight elevator Yes No      
>
> \- Loading lights Yes No      

Specifics-     

**[WAREHOUSE SPACE]{.underline}**

Warehouse space generally has concrete, woodblock, or unfinished floors,
and unfinished walls. It is specifically designed for materials storage
and handling operations and includes heavy live floor load capacity over
200 pounds per sq. ft., high ceilings over 14 feet. Warehouse space may
have HVAC at a minimum of 55 degrees Fahrenheit and lighting level of 10
foot candles at floor level and is generally contiguous or adjacent to
office or special purpose space. (A sprinkler system may be required if
ceilings are higher than 12 feet).

*Total amount of warehouse space required-*     *sq. ft.*

Describe how this space will be used-     

Will vehicles be stored: Yes No Number of vehicles-     

Flammable or hazardous storage Yes No

If yes, describe materials and quantities to be stored:

  ----------------------- ----------------------- ------------------------------
  [Name of                [Quantity of            [Special storage
  material]{.underline}   material]{.underline}   requirements]{.underline}

                                                       

                                                       

                                                       
  ----------------------- ----------------------- ------------------------------

*Comments-     *

The following special requirements may be considered above standard and
may require a lump-sum payment. Please check if required and explain if
necessary. Indicate if any of the items are Agency owned.

Space must be adjacent to office or other special use space      

Heating above 55 degrees Fahrenheit      

Minimum ceiling height-     

Ceiling hoist      

Exhaust fan      

Ceiling fan      

Unisex restroom      

Hose bib Inside Outside      

Laundry sink with hot water      

Mop sink with hot water

Floor drains with sediment trap and sump: Drain size-     

Janitorial service      

Floor load capacity exceeding 200 lb/sq. ft.      

Special electrical service (220V, 30Amp Standard: 30Amp 50Amp)      

Phone line      

Large vehicles will need maneuvering space (indicate size of vehicles)
     

Loading dock

> \- Size of trucks that will be accommodated-     
>
> \- Turning radius-     
>
> \- Dock height-     
>
> \- Dock must be enclosed/covered Yes No      
>
> \- Dock freight elevator Yes No      
>
> \- Loading lights Yes No      

Load levelers      

Loading ramp      

Overhead door Manual ­­­ Electric door opener: Size-     

Personnel door to provide access to ware yard      

Special security features (alarms, special locks)      

Special fire protection features      

Automatic fire sprinkler      

Fire hydrant or standpipe      

Air curtain      

Plastic weather curtain      

Specifics-     

**[WARE YARD]{.underline}**

This is open space used for storage of vehicles, equipment, or materials
and may or may not be fenced and lighted.

*Total amount of ware yard required in*      *sq. ft. or*      *acres.*

Describe how this space will be used:      

Ware yard located immediately adjacent to building where office is
located? Yes No

The following special requirements may be considered above standard and
may require a lump-sum payment. Please check if required and explain if
necessary.

Gravel Concrete Asphalt

Lighting in excess of 1 foot candle      

Canopy - Size:      

Hose bib     

Fence - Height:      

Barbwire      

Pedestrian gate in fence      

Vehicle gate in fence Manually Automatic      

Security requirements      

Specifics-     

**[PARKING]{.underline}**

Parking is covered under the Federal Property Management Regulation 41
CFR, 102-74.300 & 305 and MRP Directive 5400.2.

[INSIDE PARKING]{.underline}

Inside parking is space used for parking of Government vehicles and
Official Visitors which is other than in an outside lot and includes
garages, rooftop and deck parking areas.

*Number of spaces required: GOV       Visitor      *

Space must be located on-site **OR** Space must be within       blocks
of offered space

Reserved parking      

Special security measures are required, as follows-     

[OUTSIDE PARKING]{.underline}

*Number of spaces required: GOV       Visitor      *

Space must be located on-site **OR** Space must be within       blocks
of offered space

Reserved parking      

Special security measures are required, as follows-     

[EMPLOYEE PARKING]{.underline}

A minimum of       public parking spaces must be available within      
blocks of the offered space for use by employees.

[PUBLIC TRANSPORTATION]{.underline}

Satisfactory public transportation must be available within       blocks
of the offered space.

**[SPECIALTY SPACE]{.underline}**

This space covers areas with architectural features differing from
normal office and storage areas, such as sloped floors, high ceilings,
increased floor load, steel mesh within partitioning, and acoustical
treatment exceeding STC 40. Examples are libraries, security vaults,
hangars, bird rooms and magazines.

*Total amount of specialty space required:*       *sq. ft.*

Describe how this space will be used:      

Library Security vault Hangar Bird room Magazine Repeater Antenna

Collections room: Type-     

The following special requirements may be considered above standard and
may require a lump-sum payment. Please check if required and explain if
necessary.

Special locks      

Special lighting      

Built in book (library) or storage (vault) shelving      

Bi-fold hangar door: Size-     

Specifics-     

![](media/image1.png){width="0.6798611111111111in"
height="0.6798611111111111in"} **GSA Public Buildings Service**

Categorical Exclusion Checklist

Action Name: Lease Action

Action Location:      

Action Description (check one): Establish Expand Relocate Renew

Category (check one): Office Warehouse Lab

### 

+--------+-------------------------------------------+---+---+-------+
| #      |                                           | Y | N | Need  |
| ## All |                                           | e | o | Data  |
|  Check |                                           | s |   |       |
| list C |                                           |   |   |       |
| ATEX A |                                           |   |   |       |
| ctions |                                           |   |   |       |
+--------+-------------------------------------------+---+---+-------+
| **A.   |                                           |   |   | **    |
| Is the |                                           |   |   |    ** |
| action |                                           |   |   |       |
| likely |                                           |   |   |       |
| to be  |                                           |   |   |       |
| incons |                                           |   |   |       |
| istent |                                           |   |   |       |
| with   |                                           |   |   |       |
| any    |                                           |   |   |       |
| appl   |                                           |   |   |       |
| icable |                                           |   |   |       |
| Fe     |                                           |   |   |       |
| deral, |                                           |   |   |       |
| State, |                                           |   |   |       |
| Indian |                                           |   |   |       |
| t      |                                           |   |   |       |
| ribal, |                                           |   |   |       |
| or     |                                           |   |   |       |
| local  |                                           |   |   |       |
| law,   |                                           |   |   |       |
| regul  |                                           |   |   |       |
| ation, |                                           |   |   |       |
| or     |                                           |   |   |       |
| st     |                                           |   |   |       |
| andard |                                           |   |   |       |
| de     |                                           |   |   |       |
| signed |                                           |   |   |       |
| to     |                                           |   |   |       |
| p      |                                           |   |   |       |
| rotect |                                           |   |   |       |
| any    |                                           |   |   |       |
| aspect |                                           |   |   |       |
| of the |                                           |   |   |       |
| en     |                                           |   |   |       |
| vironm |                                           |   |   |       |
| ent?** |                                           |   |   |       |
+--------+-------------------------------------------+---+---+-------+
| COM    |                                           |   |   |       |
| MENTS: |                                           |   |   |       |
+--------+-------------------------------------------+---+---+-------+
| **B.   |                                           |   |   | **    |
| Is the |                                           |   |   |    ** |
| action |                                           |   |   |       |
| likely |                                           |   |   |       |
| to     |                                           |   |   |       |
| have   |                                           |   |   |       |
| r      |                                           |   |   |       |
| esults |                                           |   |   |       |
| that   |                                           |   |   |       |
| are    |                                           |   |   |       |
| incons |                                           |   |   |       |
| istent |                                           |   |   |       |
| with   |                                           |   |   |       |
| l      |                                           |   |   |       |
| ocally |                                           |   |   |       |
| d      |                                           |   |   |       |
| esired |                                           |   |   |       |
| s      |                                           |   |   |       |
| ocial, |                                           |   |   |       |
| eco    |                                           |   |   |       |
| nomic, |                                           |   |   |       |
| or     |                                           |   |   |       |
| other  |                                           |   |   |       |
| e      |                                           |   |   |       |
| nviron |                                           |   |   |       |
| mental |                                           |   |   |       |
| c      |                                           |   |   |       |
| onditi |                                           |   |   |       |
| ons?** |                                           |   |   |       |
+--------+-------------------------------------------+---+---+-------+
| COM    |                                           |   |   |       |
| MENTS: |                                           |   |   |       |
+--------+-------------------------------------------+---+---+-------+
| **C.   |                                           |   |   | **    |
| Is the |                                           |   |   |    ** |
| action |                                           |   |   |       |
| likely |                                           |   |   |       |
| to     |                                           |   |   |       |
| result |                                           |   |   |       |
| in the |                                           |   |   |       |
| use,   |                                           |   |   |       |
| st     |                                           |   |   |       |
| orage, |                                           |   |   |       |
| r      |                                           |   |   |       |
| elease |                                           |   |   |       |
| and/or |                                           |   |   |       |
| di     |                                           |   |   |       |
| sposal |                                           |   |   |       |
| of     |                                           |   |   |       |
| toxic, |                                           |   |   |       |
| haza   |                                           |   |   |       |
| rdous, |                                           |   |   |       |
| or     |                                           |   |   |       |
| radio  |                                           |   |   |       |
| active |                                           |   |   |       |
| mate   |                                           |   |   |       |
| rials, |                                           |   |   |       |
| or in  |                                           |   |   |       |
| the    |                                           |   |   |       |
| ex     |                                           |   |   |       |
| posure |                                           |   |   |       |
| of     |                                           |   |   |       |
| people |                                           |   |   |       |
| to     |                                           |   |   |       |
| such   |                                           |   |   |       |
| materi |                                           |   |   |       |
| als?** |                                           |   |   |       |
+--------+-------------------------------------------+---+---+-------+
| COM    |                                           |   |   |       |
| MENTS: |                                           |   |   |       |
+--------+-------------------------------------------+---+---+-------+
| **D.   |                                           |   |   | **    |
| Is the |                                           |   |   |    ** |
| action |                                           |   |   |       |
| likely |                                           |   |   |       |
| to     |                                           |   |   |       |
| adv    |                                           |   |   |       |
| ersely |                                           |   |   |       |
| affect |                                           |   |   |       |
| a      |                                           |   |   |       |
| signi  |                                           |   |   |       |
| ficant |                                           |   |   |       |
| aspect |                                           |   |   |       |
| of the |                                           |   |   |       |
| n      |                                           |   |   |       |
| atural |                                           |   |   |       |
| en     |                                           |   |   |       |
| vironm |                                           |   |   |       |
| ent?** |                                           |   |   |       |
+--------+-------------------------------------------+---+---+-------+
| COM    |                                           |   |   |       |
| MENTS: |                                           |   |   |       |
+--------+-------------------------------------------+---+---+-------+
| **E.   |                                           |   |   | **    |
| Is the |                                           |   |   |    ** |
| action |                                           |   |   |       |
| likely |                                           |   |   |       |
| to     |                                           |   |   |       |
| adv    |                                           |   |   |       |
| ersely |                                           |   |   |       |
| affect |                                           |   |   |       |
| a      |                                           |   |   |       |
| signi  |                                           |   |   |       |
| ficant |                                           |   |   |       |
| aspect |                                           |   |   |       |
| of the |                                           |   |   |       |
| so     |                                           |   |   |       |
| cio-cu |                                           |   |   |       |
| ltural |                                           |   |   |       |
| en     |                                           |   |   |       |
| vironm |                                           |   |   |       |
| ent?** |                                           |   |   |       |
+--------+-------------------------------------------+---+---+-------+
| COM    |                                           |   |   |       |
| MENTS: |                                           |   |   |       |
+--------+-------------------------------------------+---+---+-------+
| **F.   |                                           |   |   | **    |
| Is the |                                           |   |   |    ** |
| action |                                           |   |   |       |
| likely |                                           |   |   |       |
| to     |                                           |   |   |       |
| ge     |                                           |   |   |       |
| nerate |                                           |   |   |       |
| contr  |                                           |   |   |       |
| oversy |                                           |   |   |       |
| on     |                                           |   |   |       |
| e      |                                           |   |   |       |
| nviron |                                           |   |   |       |
| mental |                                           |   |   |       |
| grou   |                                           |   |   |       |
| nds?** |                                           |   |   |       |
+--------+-------------------------------------------+---+---+-------+
| COM    |                                           |   |   |       |
| MENTS: |                                           |   |   |       |
+--------+-------------------------------------------+---+---+-------+

  ---------------- -------------------------------------------- ---- ---- -----------
  **G. Is there a                                                         **     **
  high level of                                                           
  uncertainty                                                             
  about the                                                               
  action's                                                                
  environmental                                                           
  effects?**                                                              

  COMMENTS:                                                               

  **H. Is the                                                             **     **
  action likely to                                                        
  do something                                                            
  especially risky                                                        
  to the human                                                            
  environment?**                                                          

  COMMENTS:                                                               

  **I. Is the                                                             **     **
  action part of                                                          
  an ongoing                                                              
  pattern of                                                              
  actions (whether                                                        
  under the                                                               
  control of GSA                                                          
  or others) that                                                         
  are cumulatively                                                        
  likely to have                                                          
  adverse effects                                                         
  on the human                                                            
  environment?**                                                          

  COMMENTS:                                                               

  **J. Is the                                                             **     **
  action likely to                                                        
  set a precedent                                                         
  for, or                                                                 
  represent a                                                             
  decision in                                                             
  principle about,                                                        
  future GSA                                                              
  actions that                                                            
  could have                                                              
  significant                                                             
  effects on the                                                          
  human                                                                   
  environment?**                                                          

  COMMENTS:                                                               

  **K. Is the                                                             **     **
  action likely to                                                        
  have some other                                                         
  adverse effect                                                          
  on public health                                                        
  and safety or on                                                        
  any other                                                               
  environmental                                                           
  media or                                                                
  resources that                                                          
  are not                                                                 
  specifically                                                            
  identified                                                              
  above?**                                                                
  ---------------- -------------------------------------------- ---- ---- -----------

  ----------------------------------------------------------------- -----
  Conclusions:                                                      

  **The action is a CATEX and requires no further environmental     
  review.**                                                         

  **The action is a CATEX but requires further review under one or  
  more other environmental authorities.**                           

  **The action requires an EA.**                                    

  **The action requires an EIS.**                                   
  ----------------------------------------------------------------- -----

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_**

**Program Safety Officer Date Realty Specialist Date**

**Conclusion Comments:      **

**References:      **