+---+---+--------+-----------------+---+-----------+--------------------+
| # |   |        |                 |   |           |                    |
| # |   |        |                 |   |           |                    |
|   |   |        |                 |   |           |                    |
| P |   |        |                 |   |           |                    |
| R |   |        |                 |   |           |                    |
| E |   |        |                 |   |           |                    |
| L |   |        |                 |   |           |                    |
| I |   |        |                 |   |           |                    |
| M |   |        |                 |   |           |                    |
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| N |   |        |                 |   |           |                    |
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|   |   |        |                 |   |           |                    |
| P |   |        |                 |   |           |                    |
| R |   |        |                 |   |           |                    |
| O |   |        |                 |   |           |                    |
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| S |   |        |                 |   |           |                    |
| A |   |        |                 |   |           |                    |
| L |   |        |                 |   |           |                    |
|   |   |        |                 |   |           |                    |
| F |   |        |                 |   |           |                    |
| O |   |        |                 |   |           |                    |
| R |   |        |                 |   |           |                    |
| M |   |        |                 |   |           |                    |
+---+---+--------+-----------------+---+-----------+--------------------+
|   |   |        |                 |   |           |                    |
+---+---+--------+-----------------+---+-----------+--------------------+
| * |   |        |                 |   |           |                    |
| * |   |        |                 |   |           |                    |
| P |   |        |                 |   |           |                    |
| a |   |        |                 |   |           |                    |
| r |   |        |                 |   |           |                    |
| t |   |        |                 |   |           |                    |
|   |   |        |                 |   |           |                    |
| 1 |   |        |                 |   |           |                    |
| . |   |        |                 |   |           |                    |
| P |   |        |                 |   |           |                    |
| r |   |        |                 |   |           |                    |
| o |   |        |                 |   |           |                    |
| p |   |        |                 |   |           |                    |
| o |   |        |                 |   |           |                    |
| s |   |        |                 |   |           |                    |
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| d |   |        |                 |   |           |                    |
| W |   |        |                 |   |           |                    |
| o |   |        |                 |   |           |                    |
| r |   |        |                 |   |           |                    |
| k |   |        |                 |   |           |                    |
| D |   |        |                 |   |           |                    |
| e |   |        |                 |   |           |                    |
| s |   |        |                 |   |           |                    |
| c |   |        |                 |   |           |                    |
| r |   |        |                 |   |           |                    |
| i |   |        |                 |   |           |                    |
| p |   |        |                 |   |           |                    |
| t |   |        |                 |   |           |                    |
| i |   |        |                 |   |           |                    |
| o |   |        |                 |   |           |                    |
| n |   |        |                 |   |           |                    |
| * |   |        |                 |   |           |                    |
| * |   |        |                 |   |           |                    |
| * |   |        |                 |   |           |                    |
| ( |   |        |                 |   |           |                    |
| T |   |        |                 |   |           |                    |
| o |   |        |                 |   |           |                    |
| b |   |        |                 |   |           |                    |
| e |   |        |                 |   |           |                    |
| c |   |        |                 |   |           |                    |
| o |   |        |                 |   |           |                    |
| m |   |        |                 |   |           |                    |
| p |   |        |                 |   |           |                    |
| l |   |        |                 |   |           |                    |
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| t |   |        |                 |   |           |                    |
| e |   |        |                 |   |           |                    |
| d |   |        |                 |   |           |                    |
| b |   |        |                 |   |           |                    |
| y |   |        |                 |   |           |                    |
| t |   |        |                 |   |           |                    |
| h |   |        |                 |   |           |                    |
| e |   |        |                 |   |           |                    |
| P |   |        |                 |   |           |                    |
| r |   |        |                 |   |           |                    |
| i |   |        |                 |   |           |                    |
| n |   |        |                 |   |           |                    |
| c |   |        |                 |   |           |                    |
| i |   |        |                 |   |           |                    |
| p |   |        |                 |   |           |                    |
| a |   |        |                 |   |           |                    |
| l |   |        |                 |   |           |                    |
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| n |   |        |                 |   |           |                    |
| v |   |        |                 |   |           |                    |
| e |   |        |                 |   |           |                    |
| s |   |        |                 |   |           |                    |
| t |   |        |                 |   |           |                    |
| i |   |        |                 |   |           |                    |
| g |   |        |                 |   |           |                    |
| a |   |        |                 |   |           |                    |
| t |   |        |                 |   |           |                    |
| o |   |        |                 |   |           |                    |
| r |   |        |                 |   |           |                    |
| ) |   |        |                 |   |           |                    |
| * |   |        |                 |   |           |                    |
+---+---+--------+-----------------+---+-----------+--------------------+
|   |   |        |                 |   |           |                    |
+---+---+--------+-----------------+---+-----------+--------------------+
|   | 1 |        |                 | # | #         | #                  |
|   | \ |        |                 |   |           |                    |
|   | . |        |                 | P |           |                    |
|   | P |        |                 | P |           |                    |
|   | r |        |                 |   |           |                    |
|   | o |        |                 | \ |           |                    |
|   | p |        |                 | # |           |                    |
|   | o |        |                 |   |           |                    |
|   | s |        |                 |   |           |                    |
|   | a |        |                 |   |           |                    |
|   | l |        |                 |   |           |                    |
|   | N |        |                 |   |           |                    |
|   | u |        |                 |   |           |                    |
|   | m |        |                 |   |           |                    |
|   | b |        |                 |   |           |                    |
|   | e |        |                 |   |           |                    |
|   | r |        |                 |   |           |                    |
|   | * |        |                 |   |           |                    |
|   | ( |        |                 |   |           |                    |
|   | o |        |                 |   |           |                    |
|   | b |        |                 |   |           |                    |
|   | t |        |                 |   |           |                    |
|   | a |        |                 |   |           |                    |
|   | i |        |                 |   |           |                    |
|   | n |        |                 |   |           |                    |
|   | b |        |                 |   |           |                    |
|   | y |        |                 |   |           |                    |
|   | c |        |                 |   |           |                    |
|   | a |        |                 |   |           |                    |
|   | l |        |                 |   |           |                    |
|   | l |        |                 |   |           |                    |
|   | i |        |                 |   |           |                    |
|   | n |        |                 |   |           |                    |
|   | g |        |                 |   |           |                    |
|   | 4 |        |                 |   |           |                    |
|   | - |        |                 |   |           |                    |
|   | 6 |        |                 |   |           |                    |
|   | 4 |        |                 |   |           |                    |
|   | 8 |        |                 |   |           |                    |
|   | 6 |        |                 |   |           |                    |
|   | ) |        |                 |   |           |                    |
|   | : |        |                 |   |           |                    |
|   | * |        |                 |   |           |                    |
+---+---+--------+-----------------+---+-----------+--------------------+
|   |   |        |                 |   |           |                    |
+---+---+--------+-----------------+---+-----------+--------------------+
|   | 2 |        | #               |   |           |                    |
|   | \ |        |                 |   |           |                    |
|   | . |        |                 |   |           |                    |
|   | T |        |                 |   |           |                    |
|   | i |        |                 |   |           |                    |
|   | t |        |                 |   |           |                    |
|   | l |        |                 |   |           |                    |
|   | e |        |                 |   |           |                    |
|   | o |        |                 |   |           |                    |
|   | f |        |                 |   |           |                    |
|   | P |        |                 |   |           |                    |
|   | r |        |                 |   |           |                    |
|   | o |        |                 |   |           |                    |
|   | j |        |                 |   |           |                    |
|   | e |        |                 |   |           |                    |
|   | c |        |                 |   |           |                    |
|   | t |        |                 |   |           |                    |
|   | : |        |                 |   |           |                    |
+---+---+--------+-----------------+---+-----------+--------------------+
|   |   |        |                 |   |           |                    |
+---+---+--------+-----------------+---+-----------+--------------------+

<table>
<colgroup>
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 22%" />
<col style="width: 9%" />
<col style="width: 9%" />
<col style="width: 3%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 37%" />
</colgroup>
<tbody>
<tr class="odd">
<td></td>
<td colspan="2">3. Principal Investigator(s):</td>
<td colspan="8"><h5
id="if-conflict-of-interest-exists-please-complete-and-attach-the-form-disclosure-of-intent-to-engage-in">If
conflict of interest exists, please complete and attach the form
“Disclosure of Intent to Engage in </h5></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="9"><em>Consulting on Activity with Potential Conflict of
Interest”. See Ames Lab Consulting &amp; Conflict of Interest Policy for
reference.</em></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="3"><em>Type name(s) and telephone numbers (s)</em></td>
<td colspan="4"><em>Conflict of Interest?</em></td>
<td colspan="2"><em>Signature(s)</em></td>
</tr>
<tr class="even">
<td colspan="2" rowspan="2"></td>
<td colspan="2" rowspan="2"></td>
<td rowspan="2">294-</td>
<td colspan="4"></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><strong>Y</strong></td>
<td></td>
<td><strong>N</strong></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2" rowspan="2"></td>
<td colspan="2" rowspan="2"></td>
<td rowspan="2">294-</td>
<td colspan="4"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="odd">
<td><h1 id="y">Y</h1></td>
<td></td>
<td><h1 id="n">N</h1></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2" rowspan="2"></td>
<td colspan="2" rowspan="2"></td>
<td rowspan="2">294-</td>
<td colspan="4"></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
</tr>
<tr class="odd">
<td><strong>Y</strong></td>
<td></td>
<td><strong>N</strong></td>
<td></td>
</tr>
</tbody>
</table>

  -- ------------- --- --- --- --- --- ---- --- --- --- --- --- -------------------- -------
     4\. Project       /       /       \-       /       /       5\. Estimated        
     Duration:                                                  Funding Required:    

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

  -- ------------ --------------------------------------------------------
     6\. Funding  **     **
     Source:      

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

  -- ------------ --- ------------------- ----- -- -- -------------- -------------------------- -------------------- --- -- -- -- --
     7\. Proposed                                                                                                                 
     Funding                                                                                                                      
     Mechanism:                                                                                                                   

                      Expanded DOE                                   Work for Other DOE                                           
                      Programmatic                                   Laboratories/Contractors                                     
                      Research                                                                                                    

                      Work for Others                                Work for Others Federal                                      
                                                                     Agencies                                                     

                      CRADA                                          Other                                                        

                                                      *(Identify)*                                                                
  -- ------------ --- ------------------- ----- -- -- -------------- -------------------------- -------------------- --- -- -- -- --

  -- ------------- ------------- ----------------------------------------------------
     8\.                         
     Description                 
     of Project:                 

                                 

                                 

                                 

                                 

                                 

                   *(Continue on 
                   attachment if 
                   necessary)*   
  -- ------------- ------------- ----------------------------------------------------

  -- --------------------------- ------------- ------- ---------------------- ------- -------------- ----- -- ---- ---
     9\. Technology                                                                                                
     Transfer/Industrial                                                                                           
     Competitiveness Benefits:                                                                                     

                                                                                                                   

                                 *(Continue on                                                                     
                                 attachment if                                                                     
                                 necessary)*                                                                       

                                                                                                                   

     10\. Space in which Project                                                                                   
     will be conducted,                                                                                            
     Building/Room No.(s):                                                                                         

                                                                                                                   

                                                                                                                   

     11\. Would Project                                                                                             
     interfere with other                                                                                          
     approved work?                                                                                                

                                                                                                     Yes      No   

                                 If yes,                                                                           
                                 explain                                                                           

     12\. Could Project be                                                                                         
     conveniently/economically                                                                                     
     conducted by a private                                                                                        
     entity?                                                                                                       

                                                                                                     Yes      No   

                                 If yes,                                                                           
                                 explain                                                                           

     13\. Will results of this                                                                                     
     Project be published and                                                                                      
     shared broadly within the                                                                                     
     scientific community?                                                                                         

                                                                                                     Yes      No   

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

+---+--------------------------------------------------------+---+---+---+---+---+---+---+
| * |                                                        |   |   |   |   |   |   |   |
| * |                                                        |   |   |   |   |   |   |   |
| P |                                                        |   |   |   |   |   |   |   |
| a |                                                        |   |   |   |   |   |   |   |
| r |                                                        |   |   |   |   |   |   |   |
| t |                                                        |   |   |   |   |   |   |   |
| 2 |                                                        |   |   |   |   |   |   |   |
| . |                                                        |   |   |   |   |   |   |   |
| E |                                                        |   |   |   |   |   |   |   |
| S |                                                        |   |   |   |   |   |   |   |
| & |                                                        |   |   |   |   |   |   |   |
| H |                                                        |   |   |   |   |   |   |   |
| R |                                                        |   |   |   |   |   |   |   |
| e |                                                        |   |   |   |   |   |   |   |
| v |                                                        |   |   |   |   |   |   |   |
| i |                                                        |   |   |   |   |   |   |   |
| e |                                                        |   |   |   |   |   |   |   |
| w |                                                        |   |   |   |   |   |   |   |
| * |                                                        |   |   |   |   |   |   |   |
| ( |                                                        |   |   |   |   |   |   |   |
| t |                                                        |   |   |   |   |   |   |   |
| o |                                                        |   |   |   |   |   |   |   |
| b |                                                        |   |   |   |   |   |   |   |
| e |                                                        |   |   |   |   |   |   |   |
| c |                                                        |   |   |   |   |   |   |   |
| o |                                                        |   |   |   |   |   |   |   |
| m |                                                        |   |   |   |   |   |   |   |
| p |                                                        |   |   |   |   |   |   |   |
| l |                                                        |   |   |   |   |   |   |   |
| e |                                                        |   |   |   |   |   |   |   |
| t |                                                        |   |   |   |   |   |   |   |
| e |                                                        |   |   |   |   |   |   |   |
| d |                                                        |   |   |   |   |   |   |   |
| a |                                                        |   |   |   |   |   |   |   |
| n |                                                        |   |   |   |   |   |   |   |
| d |                                                        |   |   |   |   |   |   |   |
| s |                                                        |   |   |   |   |   |   |   |
| i |                                                        |   |   |   |   |   |   |   |
| g |                                                        |   |   |   |   |   |   |   |
| n |                                                        |   |   |   |   |   |   |   |
| e |                                                        |   |   |   |   |   |   |   |
| d |                                                        |   |   |   |   |   |   |   |
| b |                                                        |   |   |   |   |   |   |   |
| y |                                                        |   |   |   |   |   |   |   |
| t |                                                        |   |   |   |   |   |   |   |
| h |                                                        |   |   |   |   |   |   |   |
| e |                                                        |   |   |   |   |   |   |   |
| P |                                                        |   |   |   |   |   |   |   |
| r |                                                        |   |   |   |   |   |   |   |
| i |                                                        |   |   |   |   |   |   |   |
| n |                                                        |   |   |   |   |   |   |   |
| c |                                                        |   |   |   |   |   |   |   |
| i |                                                        |   |   |   |   |   |   |   |
| p |                                                        |   |   |   |   |   |   |   |
| a |                                                        |   |   |   |   |   |   |   |
| l |                                                        |   |   |   |   |   |   |   |
| I |                                                        |   |   |   |   |   |   |   |
| n |                                                        |   |   |   |   |   |   |   |
| v |                                                        |   |   |   |   |   |   |   |
| e |                                                        |   |   |   |   |   |   |   |
| s |                                                        |   |   |   |   |   |   |   |
| t |                                                        |   |   |   |   |   |   |   |
| i |                                                        |   |   |   |   |   |   |   |
| g |                                                        |   |   |   |   |   |   |   |
| a |                                                        |   |   |   |   |   |   |   |
| t |                                                        |   |   |   |   |   |   |   |
| o |                                                        |   |   |   |   |   |   |   |
| r |                                                        |   |   |   |   |   |   |   |
| a |                                                        |   |   |   |   |   |   |   |
| n |                                                        |   |   |   |   |   |   |   |
| d |                                                        |   |   |   |   |   |   |   |
| E |                                                        |   |   |   |   |   |   |   |
| S |                                                        |   |   |   |   |   |   |   |
| H |                                                        |   |   |   |   |   |   |   |
| & |                                                        |   |   |   |   |   |   |   |
| A |                                                        |   |   |   |   |   |   |   |
| ) |                                                        |   |   |   |   |   |   |   |
| * |                                                        |   |   |   |   |   |   |   |
| * |                                                        |   |   |   |   |   |   |   |
| * |                                                        |   |   |   |   |   |   |   |
+---+--------------------------------------------------------+---+---+---+---+---+---+---+
|   | > *Some proposed research may require the approval of  |   |   |   |   |   |   |   |
|   | > ISU committees (e.g. Institutional Review Board).    |   |   |   |   |   |   |   |
|   | > This approval may take several weeks and is required |   |   |   |   |   |   |   |
|   | > prior to commencement of work. Please answer the     |   |   |   |   |   |   |   |
|   | > following:*                                          |   |   |   |   |   |   |   |
+---+--------------------------------------------------------+---+---+---+---+---+---+---+
|   | > Will vertebrate animals be used in this project?     | Y |   |   | > |   |   |   |
|   |                                                        | e |   |   |   |   |   |   |
|   |                                                        | s |   |   | N |   |   |   |
|   |                                                        |   |   |   | o |   |   |   |
+---+--------------------------------------------------------+---+---+---+---+---+---+---+
|   |                                                        |   |   |   |   |   |   |   |
+---+--------------------------------------------------------+---+---+---+---+---+---+---+
|   | > Will recombinant DNA, human or animal pathogens be   | Y |   |   |   | N |   |   |
|   | > used?                                                | e |   |   |   | o |   |   |
|   |                                                        | s |   |   |   |   |   |   |
+---+--------------------------------------------------------+---+---+---+---+---+---+---+
|   |                                                        |   |   |   |   |   |   |   |
+---+--------------------------------------------------------+---+---+---+---+---+---+---+
|   | > Will human subjects be used in this project?         | Y |   |   |   | N |   |   |
|   |                                                        | e |   |   |   | o |   |   |
|   |                                                        | s |   |   |   |   |   |   |
+---+--------------------------------------------------------+---+---+---+---+---+---+---+
|   |                                                        |   |   |   |   |   |   |   |
+---+--------------------------------------------------------+---+---+---+---+---+---+---+

<table style="width:100%;">
<colgroup>
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 5%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 35%" />
<col style="width: 10%" />
<col style="width: 31%" />
<col style="width: 0%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="14"></td>
</tr>
<tr class="even">
<td colspan="3"><h4 id="section-3"></h4></td>
<td colspan="7"><h4 id="readiness-review"><strong>Readiness
Review</strong></h4></td>
<td colspan="4"><em><strong>(to be completed and signed by the Principal
Investigator and ESH&amp;A</strong>)</em></td>
</tr>
<tr class="odd">
<td colspan="14"><blockquote>
<p><em>Does the proposed project include new or significantly modified
activities, which have not been reviewed and approved by the Ames
Laboratory Safety Review Committee</em>?</p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="14"></td>
</tr>
<tr class="odd">
<td colspan="4" rowspan="2"></td>
<td></td>
<td colspan="2" rowspan="2"></td>
<td rowspan="2">YES</td>
<td rowspan="2"></td>
<td colspan="4" rowspan="2">(Please complete and attach an Activity
ES&amp;H Hazard Identification Checklist for each new or significantly
modified activity related to this proposed work.)</td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="14"></td>
</tr>
<tr class="even">
<td colspan="4" rowspan="2"></td>
<td></td>
<td colspan="2" rowspan="2"></td>
<td rowspan="2">NO</td>
<td rowspan="2"></td>
<td colspan="5" rowspan="2">(No Further Action)</td>
</tr>
<tr class="odd">
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="4" rowspan="6"></td>
<td colspan="5" rowspan="2"></td>
<td rowspan="6"></td>
<td colspan="2" rowspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="5">Principal Investigator</td>
<td colspan="2">Date</td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="5" rowspan="2"></td>
<td colspan="2" rowspan="2"></td>
</tr>
<tr class="even">
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="5">ESH&amp;A Office Representative</td>
<td colspan="2">Date</td>
</tr>
<tr class="even">
<td></td>
<td colspan="13"><blockquote>
<p>Comments:</p>
</blockquote></td>
</tr>
</tbody>
</table>

<table style="width:100%;">
<colgroup>
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 5%" />
<col style="width: 1%" />
<col style="width: 39%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 37%" />
</colgroup>
<tbody>
<tr class="odd">
<td></td>
<td colspan="8"><strong>NEPA (National Environmental Policy Act)
Implications</strong></td>
<td colspan="2"><em><strong>(to be completed by
ESH&amp;A</strong>)</em></td>
</tr>
<tr class="even">
<td colspan="11"><h6
id="does-this-proposed-project-fall-under-the-laboratorys-blanket-categorical-exclusion-b3.6-indoor-bench-scale-research-projects-and-conventional-laboratory-activities">Does
this proposed project fall under the Laboratory’s blanket Categorical
Exclusion (B3.6), “Indoor Bench-Scale Research Projects and Conventional
Laboratory Activities?” </h6></td>
</tr>
<tr class="odd">
<td colspan="11"></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td>YES</td>
<td></td>
<td colspan="4">(No Further Action)</td>
</tr>
<tr class="odd">
<td colspan="11"></td>
</tr>
<tr class="even">
<td colspan="2" rowspan="2"></td>
<td colspan="2"></td>
<td rowspan="2"></td>
<td rowspan="2">NO</td>
<td rowspan="2"></td>
<td colspan="4" rowspan="2"><p>(ESH&amp;A will have Principal
Investigator complete an <em>Environmental Evaluation Form</em>
[CH-560]</p>
<p>for further NEPA review by ESH&amp;A.)</p></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="3" rowspan="3"></td>
<td colspan="5" rowspan="2"></td>
<td colspan="2" rowspan="3"></td>
<td rowspan="2"></td>
</tr>
<tr class="odd">
</tr>
<tr class="even">
<td colspan="5">ESH&amp;A Office Representative</td>
<td>Date</td>
</tr>
<tr class="odd">
<td colspan="11"><blockquote>
<p>Comments:</p>
</blockquote></td>
</tr>
</tbody>
</table>

<table>
<colgroup>
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 5%" />
<col style="width: 6%" />
<col style="width: 39%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 3%" />
<col style="width: 14%" />
<col style="width: 15%" />
</colgroup>
<tbody>
<tr class="odd">
<td></td>
<td colspan="9"><strong>Part 3. Budget and Personnel
Requirements</strong> <em>(Completed with assistance from Budget
Office)</em></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="8"><blockquote>
<p>Include resource needs to address all aspects of the project
including ES&amp;H, NEPA, and waste disposal actions. <em>(Attach
supplementary schedule as required)</em></p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="4"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="2">Budget Office Representative</td>
<td colspan="2"></td>
<td colspan="2">Date</td>
</tr>
</tbody>
</table>

+---+-----+---+-----------------------------+------+-------------------+---+
| # |     |   |                             |      |                   |   |
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| " |     |   |                             |      |                   |   |
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+---+-----+---+-----------------------------+------+-------------------+---+
|   |     | E |                             |      | # Date            |   |
|   |     | x |                             |      |                   |   |
|   |     | p |                             |      |                   |   |
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|   |     | r |                             |      |                   |   |
+---+-----+---+-----------------------------+------+-------------------+---+
|   |     |   |                             |      |                   |   |
+---+-----+---+-----------------------------+------+-------------------+---+
|   | Re  |   |                             |      |                   |   |
|   | mar |   |                             |      |                   |   |
|   | ks: |   |                             |      |                   |   |
+---+-----+---+-----------------------------+------+-------------------+---+
|   |     |   |                             |      |                   |   |
+---+-----+---+-----------------------------+------+-------------------+---+
|   |     |   |                             |      |                   |   |
+---+-----+---+-----------------------------+------+-------------------+---+
| * |     |   |                             |      |                   |   |
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| f |     |   |                             |      |                   |   |
| t |     |   |                             |      |                   |   |
| h |     |   |                             |      |                   |   |
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| s |     |   |                             |      |                   |   |
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| o |     |   |                             |      |                   |   |
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+---+-----+---+-----------------------------+------+-------------------+---+
|   |     |   |                             |      |                   |   |
+---+-----+---+-----------------------------+------+-------------------+---+
|   |     | P |                             |      | Date              |   |
|   |     | r |                             |      |                   |   |
|   |     | o |                             |      |                   |   |
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|   |     | c |                             |      |                   |   |
|   |     | t |                             |      |                   |   |
|   |     | o |                             |      |                   |   |
|   |     | r |                             |      |                   |   |
+---+-----+---+-----------------------------+------+-------------------+---+
|   |     | A |                             |      | Date              |   |
|   |     | s |                             |      |                   |   |
|   |     | s |                             |      |                   |   |
|   |     | o |                             |      |                   |   |
|   |     | c |                             |      |                   |   |
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|   |     | D |                             |      |                   |   |
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|   |     |   |                             |      |                   |   |
|   |     | S |                             |      |                   |   |
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|   |     | d |                             |      |                   |   |
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|   |     | i |                             |      |                   |   |
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|   |     | i |                             |      |                   |   |
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|   |     | n |                             |      |                   |   |
+---+-----+---+-----------------------------+------+-------------------+---+
|   |     | D |                             |      | Date              |   |
|   |     | e |                             |      |                   |   |
|   |     | p |                             |      |                   |   |
|   |     | u |                             |      |                   |   |
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|   |     | t |                             |      |                   |   |
|   |     | o |                             |      |                   |   |
|   |     | r |                             |      |                   |   |
+---+-----+---+-----------------------------+------+-------------------+---+
| S |     |   |                             |      |                   |   |
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| m |     |   |                             |      |                   |   |
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| 8 |     |   |                             |      |                   |   |
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| 4 |     |   |                             |      |                   |   |
| 8 |     |   |                             |      |                   |   |
| 1 |     |   |                             |      |                   |   |
| . |     |   |                             |      |                   |   |
| 1 |     |   |                             |      |                   |   |
| - |     |   |                             |      |                   |   |
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| ; |     |   |                             |      |                   |   |
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+---+-----+---+-----------------------------+------+-------------------+---+