**NASA Wallops Flight Facility Site-Wide Environmental Assessment**

**NEPA Checklist**

PROJECT NAME: [     ]{.underline}

PROJECT CONTACT: [     ]{.underline} TELEPHONE: [     ]{.underline}
MAILSTOP: [     ]{.underline}

PROJECT START DATE: [     ]{.underline} PROJECT LOCATION:
[     ]{.underline}

***Instructions:** This* *checklist is to be completed for proposed NASA
actions at Wallops Flight Facility(WFF) to determine if the action is
covered by the December 2004 NASA Wallops Flight Facility Site-Wide
Environmental Assessment (Site-Wide EA). If the action is covered by the
Site-Wide EA (as determined by this checklist) and all applicable
sections of this checklist have been completed, a Record of
Environmental Consideration (REC) will be prepared documenting the
determination, and no further NEPA documentation will be required. If
the checklist indicates the need for additional analysis or that the
action is not adequately covered under the Site-Wide EA, then a REC will
be prepared that includes sufficient documentation of the additional
analysis to support a determination of no significant impact. An
Environmental Assessment (EA) will be completed if substantial
additional analysis is required to determine direct, indirect, or
cumulative impacts.*

*This checklist and the Site-Wide EA are only applicable to NASA WFF
actions and customer actions that use NASA-owned facilities at WFF.*

**I. PROJECT ELIGIBILITY FOR COVERAGE UNDER THE SITE-WIDE EA**

**PROJECT DESCRIPTION:** [     ]{.underline}

[     ]{.underline}

[     ]{.underline}

**PROJECT OWNER AND LOCATION** [     ]{.underline}

[     ]{.underline}

For **New Construction, Repair/Renovation/Relocation, or Demolition**
projects complete **Part 1.**

For **Routine Site Activities and Maintenance** projects complete **Part
2**.

For **Operational** projects complete **Part 3.**

+-----------------------------------------------------------------------+
| **PART 1 -- CONSTRUCTION PROJECTS**                                   |
+-----------------------------------------------------------------------+
| ***Check one: New Construction*** ***Repair/Renovation/Relocation***  |
| ***Demolition***                                                      |
+-----------------------------------------------------------------------+
| Would the project involve new construction in the Atlantic Ocean? Yes |
| No                                                                    |
+-----------------------------------------------------------------------+
| If YES, **Stop Here**. This project cannot be covered under the       |
| Site-Wide EA. Separate NEPA documentation must be prepared.           |
+-----------------------------------------------------------------------+
| If NO, would the project involve construction within an Area of       |
| Increased Sensitivity identified on Figures 6a, 6b, or 6c of the      |
| Site-Wide EA?                                                         |
+-----------------------------------------------------------------------+
| > If YES, complete Section II, Parts A through K and Section III of   |
| > the NEPA checklist **and include sufficient documentation with the  |
| > REC to support a determination of no significant impact on          |
| > sensitive resources.**                                              |
+-----------------------------------------------------------------------+
| > If NO, complete Section II, Parts A through K and Section III of    |
| > NEPA checklist.                                                     |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **PART 2 -- ROUTINE SITE ACTIVITIES AND MAINTENANCE**                 |
+-----------------------------------------------------------------------+
| Would the project involve one or more of the routine site activities  |
| and maintenance operations listed below or discussed in Section 2.1.3 |
| of the Site-Wide EA? **(Check all project items that apply)**         |
|                                                                       |
| Sea wall repair or enhancement                                        |
|                                                                       |
| Causeway fender repair or replacement                                 |
|                                                                       |
| Wallops Island shoreline maintenance (**Note: for projects involving  |
| dock repair/replacement or channel dredging, USACE must complete      |
| separate NEPA and environmental documentation**).                     |
|                                                                       |
| > Wildlife management                                                 |
| >                                                                     |
| > Brush and tree clearing for airspace maintenance                    |
|                                                                       |
| Utility infrastructure upgrade, repair, or replacement including      |
| storm drainage system, potable water systems, sanitary sewer systems, |
| steam heating lines, electrical lines and generators, telephone       |
| systems, or T-3 LAN communication systems.                            |
|                                                                       |
| Transportation infrastructure upgrade, repair, removal or replacement |
| including roads, sidewalks, and parking lots.                         |
|                                                                       |
| Fabrication activities in Building F-7, F-10, and N-159.              |
|                                                                       |
| Payload processing **(Note: Part 3I of Checklist must also be         |
| completed)**                                                          |
|                                                                       |
| Fueling, fuel storage, and mobile Liquid Fueling Facility (**(Note:   |
| Part 3C of Checklist must also be completed and** **fuel storage and  |
| use must be in compliance with the WFF ICP)**                         |
|                                                                       |
| Storage                                                               |
|                                                                       |
| Safety and security measure upgrades.                                 |
|                                                                       |
| Fire suppression system repair, replacement or upgrade.               |
|                                                                       |
| Other action as described in Section 2.1.3 of the Site-Wide EA. List  |
| action here                                                           |
|                                                                       |
| [     ]{.underline}                                                   |
+-----------------------------------------------------------------------+
| > If NO, **Stop Here**. This project cannot be covered under the      |
| > Site-wide EA without further NEPA documentation.                    |
+-----------------------------------------------------------------------+
| > If YES, would the project involve new construction (project does    |
| > not repair or replace an existing structure or system)?             |
+-----------------------------------------------------------------------+
| > If YES, complete PART 1 -- CONSTRUCTION PROJECTS above.             |
+-----------------------------------------------------------------------+
| > If NO, complete Section II, Parts A through K and Section III of    |
| > the NEPA checklist.                                                 |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **PART 3 -- OPERATIONAL PROJECTS**                                    |
+-----------------------------------------------------------------------+
| Only projects involving the operations listed below are potentially   |
| eligible for coverage under the Site-Wide EA. Complete the            |
| appropriate checklist part(s) referenced below for all components of  |
| the proposed project to determine eligibility for coverage under the  |
| Site-Wide EA.                                                         |
+-----------------------------------------------------------------------+
| > ***Proposed Operation***                                            |
| >                                                                     |
| > Rocket Operations (Orbital, Sounding, or Drones) Complete Parts 3A, |
| > 3B, and 3C                                                          |
| >                                                                     |
| > Balloons Complete Part 3D                                           |
| >                                                                     |
| > Piloted Aircraft Complete Part 3E                                   |
| >                                                                     |
| > Uninhabited Aerial Vehicles Complete Part 3F                        |
| >                                                                     |
| > Autonomous Underwater Vehicles Complete Part 3G                     |
| >                                                                     |
| > Payloads Complete Part 3H                                           |
| >                                                                     |
| > Tracking and Data Systems Complete Part 3I                          |
| >                                                                     |
| > Scientific Research Programs and Facilities Complete Part 3J        |
| >                                                                     |
| > Educational Programs If no new construction, no further NEPA        |
| > documentation required\*                                            |
| >                                                                     |
| > Open Burn Area Complete Part 3K                                     |
| >                                                                     |
| > Rocket Boosted Projectile Testing Complete Part 3L                  |
| >                                                                     |
| > Airfield Operations If no new construction, no further NEPA         |
| > documentation required\*                                            |
| >                                                                     |
| > \* If the project involves new construction you must complete PART  |
| > 1 -- CONSTRUCTION PROJECTS above.                                   |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Part 3A: Rockets (Orbital, Sounding or Drones)**                    |
+-----------------------------------------------------------------------+
| Would the rocket exceed the solid propellant weight of the Athena-3   |
| (approximately 133,120 kilograms \[293,479 pounds\]) class vehicle    |
| **or** exceed the launch/mission rate listed below?                   |
|                                                                       |
| > Orbital Rockets -- 12 launches per year                             |
| >                                                                     |
| > Sounding rockets -- 60 launches per year                            |
| >                                                                     |
| > Drone Targets -- 30 missions per year                               |
+-----------------------------------------------------------------------+
| > If YES, **Stop Here**. This project cannot be covered under the     |
| > Site-Wide EA without further NEPA documentation.                    |
+-----------------------------------------------------------------------+
| > If NO, **complete Section II, Parts A through K and Section III**   |
| > **of the NEPA Checklist and provide documentation with the REC to   |
| > demonstrate compliance with the orbital rocket envelope above.**    |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Part 3B: Fuel Types**                                               |
+-----------------------------------------------------------------------+
| Would the project involve the use, storage, or transportation of any  |
| fuel not listed below:                                                |
|                                                                       |
| (check all fuels that will be involved in action)                     |
|                                                                       |
| > Heating oil #2 or #6                                                |
| >                                                                     |
| > Jet fuel JP-5 or JPTS                                               |
| >                                                                     |
| > Diesel fuel                                                         |
| >                                                                     |
| > Gasoline                                                            |
| >                                                                     |
| > Kerosene                                                            |
| >                                                                     |
| > Hydroxyl-terminated polybutadiene                                   |
| >                                                                     |
| > Ammonium perchlorate/aluminum                                       |
| >                                                                     |
| > Nitrocellulose/nitroglycerin                                        |
| >                                                                     |
| > Liquid oxygen, hydrogen, or nitrogen                                |
| >                                                                     |
| > Hydrogen Peroxide                                                   |
| >                                                                     |
| > Hydrazine or its derivatives                                        |
| >                                                                     |
| > Hybrid mixture                                                      |
+-----------------------------------------------------------------------+
| > If NO, **complete Section II, Parts A through K and Section III**   |
| > **of the NEPA Checklist**                                           |
+-----------------------------------------------------------------------+
| > If YES, would the project involve the use of a hybrid fuel?         |
+-----------------------------------------------------------------------+
| > If NO, **Stop Here**. This project cannot be covered under the      |
| > Site-Wide EA without further NEPA documentation.                    |
+-----------------------------------------------------------------------+
| > If YES, would the hybrid fuel use exceed the environmental impacts  |
| > or the safety risks of the solid fuels analyzed in the Site-Wide    |
| > EA? (see Section 2.2.1 of the Site-Wide EA)                         |
+-----------------------------------------------------------------------+
| > **If No, complete Section II, Parts A through K and Section III**   |
| > **of the NEPA Checklist and include sufficient documentation with   |
| > the REC to demonstrate that the hybrid fuel will not exceed the     |
| > environmental impacts or the safety risks of the solid fuels        |
| > analyzed in the Site-Wide EA.**                                     |
+-----------------------------------------------------------------------+
| > If YES**, Stop Here**. This project cannot be covered under the     |
| > Site-Wide EA without further NEPA documentation.                    |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Part 3C: Motor Types**                                              |
+-----------------------------------------------------------------------+
| Would the motor(s) proposed for use exceed the enveloped emissions of |
| the Castor 120^TM^ with eight Castor IV^TM^ strap-ons?                |
+-----------------------------------------------------------------------+
| > If YES, **Stop Here**. This project cannot be covered under the     |
| > Site-Wide EA without further NEPA documentation.                    |
+-----------------------------------------------------------------------+
| > If NO, **complete Section II, Parts A through K and Section III**   |
| > **of the NEPA Checklist and provide documentation with the REC to   |
| > demonstrate compliance with the motor type envelope above.**        |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Part 3D: Balloons**                                                 |
+-----------------------------------------------------------------------+
| Would the balloon to be launched at WFF be larger than 1,132,673      |
| cubic meters (40,000,000 cubic feet) and have a payload larger than   |
| 3,628 kilograms (8,000 pounds)?                                       |
+-----------------------------------------------------------------------+
| > If YES, **Stop Here**. This project cannot be covered under the     |
| > Site-Wide EA without further NEPA documentation.                    |
+-----------------------------------------------------------------------+
| > If NO, **complete Section II, Parts A through K and Section III**   |
| > **of the NEPA Checklist.**                                          |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Part 3E: Piloted Aircraft**                                         |
+-----------------------------------------------------------------------+
| Would the project change flight operations by more than 25 percent or |
| require additional airfield infrastructure for the basing of non-NASA |
| aircraft? If additional infrastructure is required for the basing of  |
| non-NASA aircraft, an EA or EIS would be required depending on the    |
| quantity of aircraft and potential for impacts.                       |
+-----------------------------------------------------------------------+
| > If YES, **Stop Here**. This project cannot be covered under the     |
| > Site-Wide EA without further NEPA documentation.                    |
+-----------------------------------------------------------------------+
| > If NO, **complete Section II, Parts A through K and Section III**   |
| > **of the NEPA Checklist.**                                          |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Part 3F: Uninhabited Aerial Vehicles**                              |
+-----------------------------------------------------------------------+
| Would the test vehicle be included in the envelopes described in      |
| Table 3F (below)?                                                     |
+-----------------------------------------------------------------------+
| > If YES, **complete Section II, Parts A through K and Section III**  |
| > **of the NEPA Checklist and provide documentation with the REC to   |
| > demonstrate compliance with the envelopes in Table 3F below.**      |
+-----------------------------------------------------------------------+
| > If NO, **Stop Here**. This project cannot be covered under the      |
| > Site-Wide EA without further NEPA documentation.                    |
+-----------------------------------------------------------------------+
| +------------------------------------------------------------------+  |
| | **Table 3F: Uninhabited Aerial Vehicle Envelopes**               |  |
| +------------------------------------------------------------------+  |
| | **Size:** Does not exceed one-fifth scale Boeing 757:            |  |
| |                                                                  |  |
| | **Thrust:** Does not exceed 3,946 kg (8,700 lbs.)                |  |
| |                                                                  |  |
| | **Fuel:** Not more than 8,695 L (2,297 gal.) of Jet-A fuel.      |  |
| |                                                                  |  |
| | **Payload:** Maximum 6,550 kg (14,442 lbs.) with total weight of |  |
| | 23,133 kg (51,000 lbs.).                                         |  |
| +------------------------------------------------------------------+  |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Part 3G: Autonomous Underwater Vehicles**                           |
+-----------------------------------------------------------------------+
| Would the test vehicle be included in the envelopes described in      |
| Table 3G (below)?                                                     |
+-----------------------------------------------------------------------+
| > If YES, **complete Section II, Parts A through K and Section III**  |
| > **of the NEPA Checklist and provide documentation with the REC to   |
| > demonstrate compliance with the envelopes in Table 3G (below).**    |
+-----------------------------------------------------------------------+
| > If NO, **Stop Here**. This project cannot be covered under the      |
| > Site-Wide EA without further NEPA documentation.                    |
+-----------------------------------------------------------------------+
| +------------------------------------------------------------------+  |
| | **Table 3G: Autonomous Underwater Vehicle Envelopes**            |  |
| +------------------------------------------------------------------+  |
| | Does not exceed size and depth capability of International       |  |
| | Submarine Engineers' Theseus vehicle:                            |  |
| |                                                                  |  |
| | **Size:** Diameter: 1.27m (4 ft); Length: 10.6 m (35 ft),        |  |
| | Weight: 8,618 kg (19,000 lbs.)                                   |  |
| |                                                                  |  |
| | **Depth capability:** 1,000 m (3,281 ft)                         |  |
| +------------------------------------------------------------------+  |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Part 3H: Payloads**                                                 |
+-----------------------------------------------------------------------+
| Would the proposed payload be included in the envelopes described in  |
| Table 3H (below)?                                                     |
+-----------------------------------------------------------------------+
| > If YES, **complete Section II, Parts A through K and Section III**  |
| > **of the NEPA Checklist.**                                          |
+-----------------------------------------------------------------------+
| > If NO, **Stop Here**. This project cannot be covered under the      |
| > Site-Wide EA without further NEPA documentation.                    |
+-----------------------------------------------------------------------+
|   ---                                                                 |
| ------------ --------------------------------- ---------------------- |
|   **Table 3H:                                                         |
|   Payload                                                             |
|   Envelopes**                                                         |
|                                                                       |
|   **Component**   **Envelope**                      **Additional      |
|                                                     Documentation     |
|                                                                       |
|                                                 Requirement for REC** |
|                                                                       |
|   *                                                                   |
| *Radio         Electromagnetic fields must be    Radio frequency data |
|   Fr                                                                  |
| equency**     within ANSI-recognized acceptable confirming compliance |
|                   levels as stated in IEEE                            |
|                   C95.1-1991.                                         |
|                                                                       |
|   **                                                                  |
| Lasers**      Meets ANSI safety standards (ANSI Laser data confirming |
|                   Z136.1-2000 and Z136.6-2000).     compliance        |
|                                                                       |
|                                                                       |
| **Radioactive   Quantity and type of radioactive  Copy of Radioactive |
|                                                                       |
| Materials**     material are within the approval  Materials Report as |
|                                                                       |
|               authority level of the NASA       per NPR8715.3 Section |
|                   Nuclear Flight Safety Assurance   5.5.2.            |
|                   Manager.                                            |
|                                                                       |
|   **Biological    Biological agents must meet       Laboratory data   |
|   Ag                                                                  |
| ents**        conditions of Biosafety Level 1   confirming compliance |
|                   of the NIH and CDC Biosafety in                     |
|                   Microbiological and Biomedical                      |
|                   Laboratories.                                       |
|                                                                       |
|   **C                                                                 |
| hemical      Must not pose a substantial       Sufficient analysis to |
|                                                                       |
|  Release**       hazard and cannot have a          support compliance |
|                   significant adverse effect on the                   |
|                   atmosphere.                                         |
|                                                                       |
|                                                                       |
| **Orbital       Must comply with the requirements A debris assessment |
|   Debris          of NPD 8710.3 NASA Policy for     would need to be  |
|   G                                                                   |
| eneration**    Limiting Orbital Debris           prepared as required |
|                   Generation and NSS 1740.1.        by this policy.   |
|                                                                       |
|   **F                                                                 |
| uel**        Re-entry payload must not exceed  Sufficient analysis to |
|                                                                       |
|                 90 kilograms (200 pounds) of      support compliance. |
|                   fuel. Must comply with the                          |
|                   requirements of NPD 8700.2A, NASA                   |
|                   Policy for Safety and Mission                       |
|                   Assurance (SMA) for Experimental                    |
|                   Aerospace Vehicles (EAV)                            |
|                   (Revalidated 4/28/04)                               |
|                                                                       |
|   **Misc.**       Must comply with the requirements                   |
|                   of NPD 8700.3A, SMA Policy for                      |
|                   NASA Spacecraft, Instruments, and                   |
|                   Launch Services.                                    |
|   ---                                                                 |
| ------------ --------------------------------- ---------------------- |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Part 3I: Tracking and Data Systems**                                |
+-----------------------------------------------------------------------+
| Would the radio frequency electromagnetic fields be within            |
| ANSI-recognized acceptable levels as stated in IEEE C95.1-1991?       |
+-----------------------------------------------------------------------+
| > If YES, **complete Section II, Parts A through K and Section III**  |
| > **of the NEPA Checklist.**                                          |
+-----------------------------------------------------------------------+
| > If NO, **Stop Here**. This project cannot be covered under the      |
| > Site-Wide EA without further NEPA documentation.                    |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Part 3J: Scientific Research Programs and Facilities**              |
+-----------------------------------------------------------------------+
| Would the proposed project comply with the envelopes described in     |
| Table 3J (below)?                                                     |
+-----------------------------------------------------------------------+
| > If YES, **complete Section II, Parts A through K and Section III**  |
| > **of NEPA Checklist.**                                              |
+-----------------------------------------------------------------------+
| > If NO, **Stop Here**. This project cannot be covered under the      |
| > Site-Wide EA without further NEPA documentation.                    |
|                                                                       |
|   ---                                                                 |
| ------------ --------------------------------- ---------------------- |
|   **Table 3J:                                                         |
|   Scientific                                                          |
|   Research                                                            |
|   Programs and                                                        |
|   Facilities                                                          |
|   Envelopes**                                                         |
|                                                                       |
|   **Component**   **Envelope**                      **Additional      |
|                                                     Documentation     |
|                                                                       |
|                                                 Requirement for REC** |
|                                                                       |
|   *                                                                   |
| *Radio         Electromagnetic fields must be    Radio frequency data |
|   Fre                                                                 |
| quency**     within ANSI-recognized acceptable confirming compliance. |
|                   levels as stated in IEEE                            |
|                   C95.1-1991.                                         |
|                                                                       |
|                                                                       |
|  **Radioactive   NASA's Safety Office and the      Ionizing radiation |
|   Mat                                                                 |
| erials**     Radiation Safety Committee have   confirming compliance; |
|                                                                       |
|                  been consulted and (for projects  for sources submit |
|                                                                       |
|               involving ionizing radiation) the GSFC Forms 23-6I, and |
|                                                                       |
|                project would be in compliance    23-28I, for emitting |
|                                                                       |
|                with NASA's NRC license           equipment GSFC Forms |
|                                                                       |
|                                                    23-6ID and 23-28ID |
|                                                                       |
|   **                                                                  |
| Lasers**      Meets ANSI safety standards (ANSI Laser data confirming |
|                   Z136.1-2000 and Z136.6-2000)      compliance        |
|                                                                       |
|   **Biological    Biological agents must meet       Laboratory data   |
|   Ag                                                                  |
| ents**        conditions of Biosafety Level 1   confirming compliance |
|                   of the NIH and CDC Biosafety in                     |
|                   Microbiological and Biomedical                      |
|                   Laboratories                                        |
|                                                                       |
|   **C                                                                 |
| hemical      Must not be ozone-depleting and   Sufficient analysis to |
|                                                                       |
|  Release**       cannot have significant adverse   support compliance |
|                   effect on the atmosphere.                           |
|   ---                                                                 |
| ------------ --------------------------------- ---------------------- |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Part 3K: Open Burn Area**                                           |
+-----------------------------------------------------------------------+
| Is the burn operation covered under WFF's interim VDEQ permit or the  |
| final permit (once issued) **and** would the amount of propellant to  |
| be disposed be within the annual limit of 68 metric tonnes (75 tons)? |
+-----------------------------------------------------------------------+
| > If YES, **complete Section II, Parts A through K and Section III**  |
| > **of the NEPA checklist.**                                          |
+-----------------------------------------------------------------------+
| > If NO, **Stop Here**. This project cannot be covered under the      |
| > Site-Wide EA without further NEPA documentation.                    |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Part 3L: Rocket Boosted Projectile Testing**                        |
+-----------------------------------------------------------------------+
| Would the project exceed 20 projectile tests (missions) per year?     |
+-----------------------------------------------------------------------+
| > If Yes, **Stop Here**. This project cannot be covered under the     |
| > Site-Wide EA without further NEPA documentation.                    |
+-----------------------------------------------------------------------+
| > If No, **complete Section II, Parts A through K and Section III**   |
| > **of the NEPA Checklist.**                                          |
+-----------------------------------------------------------------------+

**II. ENVIROMENTAL REVIEW CHECKLIST**

***Complete Sections A though K. Work through each resource section
until a box with "*RESOURCE EVALUATION COMPLETE*" has been checked or
the entire resource section has been completed. If the checklist
identifies the need for additional analyses or documentation, these must
be completed and described in a REC and the additional analyses must be
included with the REC to satisfy NEPA requirements.***

+-----------------------------------------------------------------------+
| **A. LAND RESOURCES**                                                 |
+-----------------------------------------------------------------------+
| > ***Topography and Drainage/Geology and Soil***                      |
+-----------------------------------------------------------------------+
| > Project would **not** cause land disturbances such as land          |
| > clearing, earth moving, and                                         |
| >                                                                     |
| > excavation. **RESOURCE EVALUATION COMPLETE**                        |
| >                                                                     |
| > Project would cause land disturbances such as land clearing, earth  |
| > moving, and excavation.                                             |
|                                                                       |
| -   Project requires a site-specific Sediment and Erosion Control     |
|     Plan if it involves:                                              |
|                                                                       |
| > \- 1,930 square meters (10,000 square feet) or more of land         |
| > disturbance;                                                        |
| >                                                                     |
| > \- 15.25 meters (100 feet) distance from a wetland;                 |
| >                                                                     |
| > \- 15.25 meters (50 feet) distance from a drainage structure and on |
| > a slope \> 7%; or                                                   |
| >                                                                     |
| > \- 30.5 meters (100 feet) distance from a drainage structure and on |
| > a slope \< 7%                                                       |
|                                                                       |
| -   Project must comply with the WFF Storm Water Pollution Prevention |
|     Plan.                                                             |
|                                                                       |
| -   Project must be included in the applicable VPDES Construction     |
|     Stormwater Permit (either Main Base or Mainland/Island) if it     |
|     would disturb 0.4 hectare (1 acre) or more of land.               |
|                                                                       |
| > Project will comply with these conditions? Yes **RESOURCE           |
| > EVALUATION COMPLETE**                                               |
| >                                                                     |
| > No ***Explain in comments section***                                |
+-----------------------------------------------------------------------+
| > Comments:                                                           |
| >                                                                     |
| >                                                                     |
| >                                                                     |
| > Impact would be Severe Moderate Minimal None                        |
| >                                                                     |
| > Additional analysis and documentation required? Yes No N/A          |
+-----------------------------------------------------------------------+
| ***Land Use***                                                        |
+-----------------------------------------------------------------------+
| > Project would be consistent with existing WFF land use and master   |
| > plans. **RESOURCE EVALUATION COMPLETE**                             |
| >                                                                     |
| > Project would **not** be consistent with existing WFF land use and  |
| > master plans. ***Explain in comments section. Additional analyses   |
| > and documentation are required.***                                  |
+-----------------------------------------------------------------------+
| Comments:                                                             |
|                                                                       |
|                                                                       |
|                                                                       |
| > Impact would be Severe Moderate Minimal None                        |
| >                                                                     |
| > Additional analysis and documentation complete? Yes No N/A          |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **B. WATER RESOURCES**                                                |
+-----------------------------------------------------------------------+
| > ***Surface Water Quality***                                         |
+-----------------------------------------------------------------------+
| > *Consider all potential impacts to surface water quality, temporary |
| > and permanent, including indirect impacts such as stormwater        |
| > discharges from construction.*                                      |
| >                                                                     |
| > Project would **not** directly or indirectly impact surface waters. |
| > **RESOURCE EVALUATION COMPLETE**                                    |
| >                                                                     |
| > Project would directly or indirectly impact surface waters.         |
| >                                                                     |
| > Impacts would be temporary                                          |
| >                                                                     |
| > BMPs for water quality protection are required and project must     |
| > comply with the WFF Storm Water Pollution Prevention Plan. A        |
| > site-specific Sediment and Erosion Control Plan and inclusion in    |
| > the applicable VPDES Construction Stormwater Permit may be          |
| > required.                                                           |
| >                                                                     |
| > Project will comply with these conditions? Yes **RESOURCE           |
| > EVALUATION COMPLETE**                                              |
|                                                                       |
| *(include conditions in Section III)* No **(*explain in comments      |
| section*)**                                                           |
|                                                                       |
| > Impacts would be permanent ***Explain in comments section.          |
| > Additional analyses and documentation are required***               |
+-----------------------------------------------------------------------+
| > Comments:                                                           |
| >                                                                     |
| >                                                                     |
| >                                                                     |
| > Impact would be Severe Moderate Minimal None                        |
| >                                                                     |
| > Additional analysis and documentation complete? Yes No N/A          |
+-----------------------------------------------------------------------+
| > ***Groundwater***                                                   |
+-----------------------------------------------------------------------+
| > Project would **not** involve modifying, replacing, or adding       |
| > groundwater supply wells. **RESOURCE EVALUATION COMPLETE**          |
| >                                                                     |
| > Project would involve modifying, replacing, or adding groundwater   |
| > supply wells.                                                       |
|                                                                       |
| Consultation with Virginia DEQ complete? Yes No                       |
|                                                                       |
| Permit(s) required? Yes (include in Section III) No                   |
|                                                                       |
| List permit(s) required [     ]{.underline}                           |
|                                                                       |
| Are project conditions required by the permit? Yes (include in        |
| Section III) No                                                       |
+-----------------------------------------------------------------------+
| > Comments:                                                           |
| >                                                                     |
| >                                                                     |
| >                                                                     |
| > Impact would be Severe Moderate Minimal None                        |
| >                                                                     |
| > Additional analysis and documentation complete? Yes No N/A          |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| > ***Wetlands and Waters of the U.S.***                               |
+-----------------------------------------------------------------------+
| > *Note: "Waters" includes waters subject to ebb and flow of tide,    |
| > wetlands, streams, impoundments, tributaries, territorial seas, and |
| > wetlands adjacent to waters previously identified.*                 |
| >                                                                     |
| > Project would **not** involve dredging or disposal of dredged       |
| > material, or excavation, filling or other modifications, or adverse |
| > effects to wetlands or waters of the U.S.                           |
| >                                                                     |
| > **AND**                                                             |
| >                                                                     |
| > Project would **not** result in piers, wharves, breakwaters,        |
| > bulkheads, jetties, weirs, transmission lines, or bank              |
| > stabilization in waters of the U.S. **RESOURCE EVALUATION           |
| > COMPLETE**                                                          |
| >                                                                     |
| > Project would involve dredging or disposal of dredged material, or  |
| > excavation, filling or other modifications, or adverse effects to   |
| > wetlands or waters of the U.S.                                      |
| >                                                                     |
| > **AND/OR**                                                          |
| >                                                                     |
| > Project would result in piers, wharves, breakwaters, bulkheads,     |
| > jetties, weirs, transmission lines, or bank stabilization in waters |
| > of the U.S.                                                         |
| >                                                                     |
| > a\. Public notification complete? YES NO                            |
| >                                                                     |
| > b\. Are there any practicable alternatives that avoid or minimize   |
| > wetland/waters impacts?                                             |
| >                                                                     |
| > YES (*explain in comments why alternative was not selected*) NO     |
| >                                                                     |
| > c\. Consultation with USACE and VDEQ/VMRC completed YES NO          |
| >                                                                     |
| > d\. Permit required? YES (*include in S*ection III) NO              |
| >                                                                     |
| > List permit(s) required [     ]{.underline}                         |
| >                                                                     |
| > e\. Are project conditions or mitigation required? YES (*include in |
| > S*ection III) NO                                                    |
+-----------------------------------------------------------------------+
| > Comments:                                                           |
| >                                                                     |
| >                                                                     |
| >                                                                     |
| > Impact would be Severe Moderate Minimal None                        |
| >                                                                     |
| > Additional analysis and documentation complete? Yes No N/A          |
+-----------------------------------------------------------------------+
| > ***Floodplains***                                                   |
+-----------------------------------------------------------------------+
| Project would not be **not** located within the 100-year floodplain   |
| or 500-year floodplain (if a                                          |
|                                                                       |
| critical facility). **RESOURCE EVALUATION COMPLETE**                  |
|                                                                       |
| Project would be located within the 100-year floodplain or 500-year   |
| floodplain (if a critical                                             |
|                                                                       |
| facility).                                                            |
|                                                                       |
| > a\. Public notification complete? YES NO                            |
| >                                                                     |
| > b\. Are there any practicable alternatives that avoid floodplain    |
| > impacts?                                                            |
| >                                                                     |
| > YES (*explain in comments why alternative was not selected*) NO     |
| >                                                                     |
| > c\. Beneficial effect on floodplain values? YES NO                  |
| >                                                                     |
| > d\. Agency consultation completed (if required) YES NO              |
| >                                                                     |
| > e\. Are project conditions required? YES (*include in S*ection III) |
| > NO                                                                  |
+-----------------------------------------------------------------------+
| > Comments:                                                           |
|                                                                       |
|                                                                       |
|                                                                       |
| > Impact would be Severe Moderate Minimal None                        |
| >                                                                     |
| > Additional analysis and documentation complete? Yes No N/A          |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| ***Coastal Zone Management***                                         |
+-----------------------------------------------------------------------+
| > Project would **not** affect coastal resources. **RESOURCE          |
| > EVALUATION COMPLETE**                                               |
| >                                                                     |
| > Project would affect coastal resources**.**                         |
| >                                                                     |
| > Project is consistent with CZMA and Virginia VCP                    |
| >                                                                     |
| > Coastal Zone Consistency Determination complete? Yes No             |
| >                                                                     |
| > Project is **not** consistent with CZMA and Virginia VCP            |
| >                                                                     |
| > ***Explain in comments section. Additional analyses and             |
| > documentation are required.***                                      |
+-----------------------------------------------------------------------+
| > Comments:                                                           |
| >                                                                     |
| >                                                                     |
| >                                                                     |
| > Impact would be Severe Moderate Minimal None                        |
| >                                                                     |
| > Additional analysis and documentation complete? Yes No N/A          |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **C. AIR QUALITY**                                                    |
+-----------------------------------------------------------------------+
| Project would **not** result in air emissions. **RESOURCE EVALUATION  |
| COMPLETE**                                                            |
|                                                                       |
| Project would result in *temporary* air emissions                     |
|                                                                       |
| > Are mitigation measures required to reduce emissions? YES (*include |
| > in Section III*)                                                    |
| >                                                                     |
| > NO                                                                  |
|                                                                       |
| Project would result in *permanen*t air emissions                     |
|                                                                       |
| Emissions would be in compliance with an existing WFF air permit.     |
|                                                                       |
| Consultation with relevant agency completed? Yes No                   |
|                                                                       |
| Emissions would **not** be in compliance with an existing WFF air     |
| permit and/or would                                                   |
|                                                                       |
| cause WFF to exceed regulated air pollutant criteria. ***Explain in   |
| comments section. Additional analyses and documentation are           |
| required***                                                           |
+-----------------------------------------------------------------------+
| > Comments:                                                           |
| >                                                                     |
| >                                                                     |
| >                                                                     |
| > Impact would be Severe Moderate Minimal None                        |
|                                                                       |
| Additional analysis and documentation complete? Yes No N/A            |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **D. NOISE**                                                          |
+-----------------------------------------------------------------------+
| > Project would **not** generate significant noise impacts.           |
| > **RESOURCE EVALUATION COMPLETE**                                    |
|                                                                       |
| Project would generate *short-term* noise impacts.                    |
|                                                                       |
| > Are mitigation measures required to reduce impacts? YES (*include   |
| > in Section III*)                                                    |
| >                                                                     |
| > (e.g., hearing protection for workers, public notification) NO      |
|                                                                       |
| Project would result in *long-term* noise impacts                     |
|                                                                       |
| Can impacts be mitigated? YES (*include mitigation measures in        |
| Section III*)                                                         |
|                                                                       |
| NO ***Explain in comments section. Additional***                      |
|                                                                       |
| ***analyses and documentation are required***                         |
+-----------------------------------------------------------------------+
| > Comments:                                                           |
| >                                                                     |
| >                                                                     |
| >                                                                     |
| > Impact would be Severe Moderate Minimal None                        |
| >                                                                     |
| > Additional analysis and documentation complete? Yes No N/A          |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **E. HAZARDOUS MATERIALS AND HAZARDOUS WASTE**                        |
+-----------------------------------------------------------------------+
| > Project would **not** involve the use, transportation, storage, or  |
| > generation of hazardous                                             |
| >                                                                     |
| > materials or hazardous waste and would not involve demolition of a  |
| > structure listed in                                                 |
| >                                                                     |
| > Table 3-16 of the Site-Wide EA. **RESOURCE EVALUATION COMPLETE**    |
| >                                                                     |
| > Project would involve the use, transportation, storage, or          |
| > generation of hazardous materials                                   |
| >                                                                     |
| > or hazardous waste [and/or]{.underline} would involve demolition of |
| > a structure listed on Table 3-16 of the Site-Wide EA.               |
| >                                                                     |
| > Project activities must be in compliance with the WFF Integrated    |
| > Contingency Plan, the SPCC Plan, the HAZCOM program, and WFF's      |
| > Large Quantity Hazardous Waste Generator permits (as applicable).   |
| > All handling of hazardous materials and waste must be in compliance |
| > with applicable local, state and Federal laws and standard          |
| > procedures.                                                         |
| >                                                                     |
| > Project will comply with these conditions? Yes **RESOURCE           |
| > EVALUATION COMPLETE**                                              |
|                                                                       |
| *(include conditions in Section III)* No ***Explain in comments       |
| section.***                                                           |
|                                                                       |
| ***Additional analyses and***                                         |
|                                                                       |
| ***documentation are required***                                      |
+-----------------------------------------------------------------------+
| > Comments:                                                           |
| >                                                                     |
| >                                                                     |
| >                                                                     |
| > Impact would be Severe Moderate Minimal None                        |
|                                                                       |
| Additional analysis and documentation complete? Yes No N/A            |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **F. RADIATION**                                                      |
+-----------------------------------------------------------------------+
| Project would **not** involve any amount of radioactive material and  |
| would not require the use or                                          |
|                                                                       |
| > generation of ionizing or nonionizing radiation (including lasers). |
| > **RESOURCE EVALUATION COMPLETE**                                    |
| >                                                                     |
| > Project would involve radioactive material and/or would require the |
| > use or generation of ionizing or nonionizing radiation (including   |
| > lasers).                                                            |
|                                                                       |
| a\. Protection guidelines and procedures for radiation sources must   |
| be followed.                                                          |
|                                                                       |
| > b\. Have NASA's Safety Office and the Radiation Safety Committee    |
| > have been consulted and (for projects involving ionizing radiation) |
| > would the project be in compliance with NASA's NRC license? YES     |
| > (*include mitigation measures in Section III*) - **RESOURCE**       |
| >                                                                     |
| > **EVALUATION COMPLETE**                                             |
|                                                                       |
| NO ***Explain in comments section. Additional analyses and***         |
|                                                                       |
| ***documentation are required***                                      |
+-----------------------------------------------------------------------+
| > Comments:                                                           |
| >                                                                     |
| >                                                                     |
| >                                                                     |
| > Impact would be Severe Moderate Minimal None                        |
| >                                                                     |
| > Additional analysis and documentation complete? Yes No N/A          |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **G. BIOLOGICAL ENVIRONMENT**                                         |
+-----------------------------------------------------------------------+
| > ***Terrestrial Wildlife And Migratory Birds***                      |
+-----------------------------------------------------------------------+
| > Project would **not** affect terrestrial wildlife or migratory      |
| > birds. **RESOURCE EVALUATION COMPLETE**                             |
| >                                                                     |
| > Project would affect terrestrial wildlife or migratory birds.       |
| >                                                                     |
| > Project is consistent with or a component of WFF's aviation safety  |
| > program for flight operations - **RESOURCE EVALUATION COMPLETE**    |
| >                                                                     |
| > Project is **not** consistent with and is **not** a component of    |
| > WFF's aviation safety program for flight operations                 |
| >                                                                     |
| > a\. Consultation with USFWS is complete and on file? Yes No         |
| >                                                                     |
| > b\. Are project conditions required? YES *(include in Section III*) |
| > NO                                                                  |
+-----------------------------------------------------------------------+
| > Comments:                                                           |
| >                                                                     |
| >                                                                     |
| >                                                                     |
| > Impact would be Severe Moderate Minimal None                        |
| >                                                                     |
| > Additional analysis and documentation complete? Yes No N/A          |
+-----------------------------------------------------------------------+
| > ***Threatened And Endangered Species***                             |
+-----------------------------------------------------------------------+
| > Project would **not** affect the physical environment (land         |
| > disturbance, vegetation removal, sedimentation,                     |
| > noise/waste/hazardous materials emission into the environment,      |
| > etc.) **RESOURCE EVALUATION COMPLETE**                              |
| >                                                                     |
| > Project would affect the physical environment.                      |
| >                                                                     |
| > Threatened or endangered species or habitat **not** present         |
| > (Provide confirmation from regulatory agencies or an explanation    |
| > (in comment section below) to justify determination) - **RESOURCE   |
| > EVALUATION COMPLETE**                                               |
| >                                                                     |
| > Threatened or endangered species or habitat potentially present     |
| >                                                                     |
| > a\. Review and consultation with USFWS, VDACS, VDGIF, VDCR, and     |
| > NMFS                                                                |
| >                                                                     |
| > complete and on file? Yes No                                        |
| >                                                                     |
| > b\. Are project conditions required? YES *(include in Section III*) |
| > NO                                                                  |
+-----------------------------------------------------------------------+
| > Comments:                                                           |
| >                                                                     |
| >                                                                     |
| >                                                                     |
| > Impact would be Severe Moderate Minimal None                        |
|                                                                       |
| Additional analysis and documentation complete? Yes No N/A            |
+-----------------------------------------------------------------------+
| > ***Marine Mammals And Fish***                                       |
+-----------------------------------------------------------------------+
| > Project would **not** affect the marine environment. **RESOURCE     |
| > EVALUATION COMPLETE**                                               |
| >                                                                     |
| > Project would affect the marine environment.                        |
| >                                                                     |
| > Project would **not** involve the use of high strength sonar and/or |
| > would be consistent with the July 5, 2000 NASA Memorandum, *Taking  |
| > of Marine Mammals Incidental to Rocket Launches from NASA Goddard   |
| > Space Flight Center's Wallops Flight Facility*- **RESOURCE          |
| > EVALUATION COMPLETE**                                               |
| >                                                                     |
| > Project would involve the use of high strength sonar and/or would   |
| > **not** be consistent with the July 5, 2000 NASA Memorandum,        |
| > *Taking of Marine Mammals Incidental to Rocket Launches from NASA   |
| > Goddard Space Flight Center's Wallops Flight Facility*. ***Explain  |
| > in comments section. Additional analyses and documentation are      |
| > required.***                                                        |
+-----------------------------------------------------------------------+
| > Comments:                                                           |
| >                                                                     |
| >                                                                     |
| >                                                                     |
| > Impact would be Severe Moderate Minimal None                        |
|                                                                       |
| Additional analysis and documentation complete? Yes No N/A            |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **H. SOCIAL AND ECONOMIC ENVIRONMENT**                                |
+-----------------------------------------------------------------------+
| > Project would **not** result in a permanent increase or decrease in |
| > operations. **RESOURCE EVALUATION COMPLETE**                        |
| >                                                                     |
| > Project would result in a permanent increase in operations, and     |
| > impacts would be beneficial. **RESOURCE EVALUATION COMPLETE**       |
| >                                                                     |
| > Project would result in a permanent decrease in operations.         |
| > ***Explain in comments section.***                                  |
+-----------------------------------------------------------------------+
| > Comments:                                                           |
| >                                                                     |
| >                                                                     |
| >                                                                     |
| > Impact would be Severe Moderate Minimal None                        |
| >                                                                     |
| > Additional analysis and documentation complete? Yes No N/A          |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **I. HEALTH AND SAFETY**                                              |
+-----------------------------------------------------------------------+
| > Project would **not** result in any health and safety impacts to    |
| > the public or WFF staff, contractors, or guests. **RESOURCE         |
| > EVALUATION COMPLETE**                                               |
| >                                                                     |
| > Project would result in health and safety impacts to the public or  |
| > WFF staff, contractors, or guests.                                  |
| >                                                                     |
| > ***Complete all of the following as appropriate:***                 |
| >                                                                     |
| > Health and safety impacts would be associated with new              |
| > construction, repair/renovation/ relocation, demolition activities, |
| > or the upgrade, removal or installation of transportation           |
| > infrastructure.                                                     |
| >                                                                     |
| > Impacts would be minimized by complying with all Federal and state  |
| > OSHA regulations and by using only trained personnel. Appropriate   |
| > signage and fencing would be placed to alert pedestrians and        |
| > motorists of project activities, as well as any changes in traffic  |
| > patterns. Project will comply with these conditions?                |
| >                                                                     |
| > Yes                                                                 |
| >                                                                     |
| > No ***Explain in comments section. Additional analyses and          |
| > documentation are required.***                                      |
| >                                                                     |
| > Health and safety impacts would be associated with the use and      |
| > storage of fuels or the storage of hazardous materials.             |
| >                                                                     |
| > NASA would comply with all applicable Federal and state regulations |
| > and the guidance provided in the ICP. Project will comply with      |
| > these conditions?                                                   |
| >                                                                     |
| > Yes                                                                 |
| >                                                                     |
| > No ***Explain in comments section. Additional analyses and          |
| > documentation are required.***                                      |
| >                                                                     |
| > Health and safety impacts would be associated with the expansion of |
| > or modifications to the WFF Security Force or Fire Department.      |
| >                                                                     |
| > All fire and security personnel would be properly trained and would |
| > be provided appropriate personal protective equipment. Project will |
| > comply with these conditions?                                       |
| >                                                                     |
| > Yes                                                                 |
| >                                                                     |
| > No ***Explain in comments section. Additional analyses and          |
| > documentation are required.***                                      |
| >                                                                     |
| > Health and safety impacts would be associated with orbital and/or   |
| > suborbital rocket operations.                                       |
| >                                                                     |
| > The range user will submit formal documentation pertaining to the   |
| > proposed activity to the WFF Range Safety Branch for formal review. |
| > Ground and flight safety plans will be developed and approved prior |
| > to operation. Project complies with these conditions?               |
| >                                                                     |
| > Yes                                                                 |
| >                                                                     |
| > No ***Explain in comments section. Additional analyses and          |
| > documentation are required.***                                      |
| >                                                                     |
| > Health and safety impacts would be associated with balloon          |
| > operations, piloted aircraft operations, or uninhabited aerial      |
| > vehicle operations.                                                 |
| >                                                                     |
| > Project would be consistent with WFF's aviation safety program?     |
| >                                                                     |
| > Yes                                                                 |
| >                                                                     |
| > No ***Explain in comments section. Additional analyses and          |
| > documentation are required.***                                      |
|                                                                       |
| Health and safety impacts would be associated with the use of lasers. |
|                                                                       |
| > Personnel operating lasers or in the vicinity of laser operations   |
| > would be properly trained and would be provided appropriate         |
| > personal protective equipment when necessary. Laser use would       |
| > comply with all Federal and state OSHA regulations?                 |
| >                                                                     |
| > Yes                                                                 |
| >                                                                     |
| > No ***Explain in comments section. Additional analyses and          |
| > documentation are required.***                                      |
| >                                                                     |
| > Health and safety impacts would be associated with the use of       |
| > radioactive materials.                                              |
| >                                                                     |
| > The radioactive materials are within the approval authority of the  |
| > Nuclear Flight Safety Assurance Manager?                            |
| >                                                                     |
| > Yes                                                                 |
| >                                                                     |
| > No ***Explain in comments section. Additional analyses and          |
| > documentation are required.***                                      |
+-----------------------------------------------------------------------+
| > Comments:                                                           |
| >                                                                     |
| >                                                                     |
| >                                                                     |
| > Impact would be Severe Moderate Minimal None                        |
| >                                                                     |
| > Additional analysis and documentation complete? Yes No N/A          |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **J. CULTURAL RESOURCES**                                             |
+-----------------------------------------------------------------------+
| ***Historic Structures***                                             |
+-----------------------------------------------------------------------+
| Project would **not** affect any structure over 50 years old and does |
| not involve construction within 1,000 meters (3,280 feet) of any      |
| potentially historic structure identified in the 2004 Historic        |
| Resources and Eligibility Report. **RESOURCE EVALUATION COMPLETE**    |
|                                                                       |
| Project would affect a structure over 50 years old.                   |
|                                                                       |
| > Structure is **not** eligible for listing in the NRHP (see 2004     |
| > Historic Resources and Eligibility Report) and project does not     |
| > involve construction within 1,000 meters (3,280 feet) of any        |
| > potentially historic structure. **RESOURCE EVALUATION COMPLETE**    |
| >                                                                     |
| > Structure is eligible for listing in the NRHP and/or is within 1000 |
| > meters (3,280) of any potentially historic structure (see 2004      |
| > Historic Resources and Eligibility Report)                          |
| >                                                                     |
| > Review and consultation with VDHR completed and on file             |
| >                                                                     |
| > Effect Determination [     ]{.underline} ( No effect, no adverse    |
| > effect, adverse effect)                                             |
|                                                                       |
| Are project conditions required by VDHR? YES *(include in Section     |
| III*)                                                                 |
|                                                                       |
| > NO                                                                  |
+-----------------------------------------------------------------------+
| > Comments:                                                           |
| >                                                                     |
| >                                                                     |
| >                                                                     |
| > Impact would be Severe Moderate Minimal None                        |
|                                                                       |
| Additional analysis and documentation complete? Yes No N/A            |
+-----------------------------------------------------------------------+
| ***Archaeological Resources***                                        |
+-----------------------------------------------------------------------+
| > Project would **not** involve disturbance of previously undisturbed |
| > ground. **RESOURCE EVALUATION COMPLETE**                            |
| >                                                                     |
| > Project would involve disturbance of previously undisturbed ground  |
| >                                                                     |
| > Project would **not** be located in an identified area with         |
| > moderate or high archaeological sensitivity (see 2004 Historic      |
| > Resources and Eligibility Report). **RESOURCE EVALUATION COMPLETE** |
| >                                                                     |
| > Project would be located in an identified area with high            |
| > archaeological sensitivity (see 2004 Historic Resources and         |
| > Eligibility Report)                                                 |
| >                                                                     |
| > Review and consultation with VDHR completed and on file             |
| >                                                                     |
| > Effect Determination [     ]{.underline} ( No effect, no adverse    |
| > effect, adverse effect)                                             |
| >                                                                     |
| > Are project conditions or mitigation required?                      |
| >                                                                     |
| > YES *(include in Section III*) NO                                   |
+-----------------------------------------------------------------------+
| > Comments:                                                           |
| >                                                                     |
| >                                                                     |
| >                                                                     |
| > Impact would be Severe Moderate Minimal None                        |
|                                                                       |
| Additional analysis and documentation complete? Yes No N/A            |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **K. ENVIRONMENTAL JUSTICE**                                          |
+-----------------------------------------------------------------------+
| Project would **not** result in adverse effects of any nature to any  |
| population. **RESOURCE EVALUATION COMPLETE**                          |
|                                                                       |
| No low-income or minority populations occur in or near the project    |
| area. **RESOURCE EVALUATION COMPLETE**                                |
|                                                                       |
| Low-income or minority populations occur in or near the project area. |
|                                                                       |
| > Project would **not** result in disproportionately high and adverse |
| > effects on low-income or minority populations. **RESOURCE           |
| > EVALUATION COMPLETE**                                               |
| >                                                                     |
| > Project would result in disproportionately high and adverse effects |
| > on low-income or minority populations. ***Explain in comments       |
| > section. Additional analyses and documentation are required.***     |
+-----------------------------------------------------------------------+
| > Comments:                                                           |
| >                                                                     |
| >                                                                     |
| >                                                                     |
| > Impact would be Severe Moderate Minimal None                        |
|                                                                       |
| Additional analysis and documentation complete? Yes No N/A            |
+-----------------------------------------------------------------------+

**III. PROJECT CONDITIONS AND MITIGATION MEASURES**

***List all required project conditions and mitigation measures that
were identified in Items A through K*** of Section II.

+-----------------------------------------------------------------------+
| 1.  [     ]{.underline}                                               |
|                                                                       |
| 2.  [     ]{.underline}                                               |
|                                                                       |
| 3.  [     ]{.underline}                                               |
|                                                                       |
| 4.  [     ]{.underline}                                               |
|                                                                       |
| 5.  [     ]{.underline}                                               |
|                                                                       |
| 6.  [     ]{.underline}                                               |
|                                                                       |
| 7.  [     ]{.underline}                                               |
|                                                                       |
| 8.  [     ]{.underline}                                               |
|                                                                       |
| 9.  [     ]{.underline}                                               |
|                                                                       |
| 10. [     ]{.underline}                                               |
+-----------------------------------------------------------------------+