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• <br />40 <br />SAMPLE tIELD NDTM CH€zCK IST <br />Project Numbe HUD Progam� genii i vP nTF,_rr) 0 ^�7 <br />g,� <br />Pmject Name: x"x Family Options Transitional Housing. Program <br />Liombon720 4th Street Vero Beach, FL 32960 <br />(Steel) (city) (countylstate) (up Code) <br />Number of Dwelling Unita New construction ( ) Rehabilitation (<I <br />Project site is in a location described as: ( ) Cxnuai city ( ),Suburban <br />( ) Infill urban dvmlapmcat ( ) In developing rural area ( ) In undeveloped area <br />NOTE TQ READFJL' An Environmental Asaeasment (EA) Is a oonclae public document that a <br />Federal agency must prepare in order to comply with the National Environmental Polley Act <br />(NEPA) and the related Federal environmental larva and authorities. The EA must support <br />decison making process and provide s clear rationale, justification, and documentation for <br />ratings assigned. <br />INSTRUCTIONS <br />It is recommended that this checklist be used by HIID staff 1Dho prepare the Environ m e'Ql Assessment <br />(EA, Fo»n HURL -V28). It will const tate fulldvcumentdtion for marry factors on pig <br />documentation for others. It will avoid narrative rrpwu and etpedke the rreyiirotl�a�ena <br />li revised version o process. jAppertdir C of Handbook 13911 should be used <br />pThis checklLst which is a sli <br />endixgrevisio>r Of Handbook 13982 <br />• The number for each checkaheet to is the number that appears c� farm HIM -4128 Rlro, each <br />cheeklisr etlelheading is followed by a reference to where the topic appears in the current Handbook 1340.2 <br />Before the site visit, review the Phase f and all background information submitted with the application (if <br />ois c e). During the e <br />ann this visit the Prepare" of form HUD -4128 are to. (I) answer all relevant questions <br />hecklirr (ii) use rhe <br />he spaces provided for cwrurrents to include supplemental information as well as <br />ro record any recommended mitigation measures or requirements for project approva4. (ill) key year answers <br />to the relevant questions (using additional sheen ofPaPe to provide mare detailed information); anis (iv) <br />use the spaces provided for source documentation to cite the information source used (eg., title of a <br />technical report map, or special study; site &Wcdon/f old observation; name and location of the qualified <br />data saurce(s) than provided the infamnavont for example, the local planning agenry, the local housing <br />andlor community development agency, she Slate envirrn mental protection agenq,, the State Historic <br />Preservation pace, OF other qualated data source.) <br />Preparenx are. to obtain and use, as appropriate, any envbmmrrtal report (Federal, State, or local) that <br />miry have already been prepared for the property or area in which the property is locates[ <br />Several different types of maps will be useful in completing the review, such as the project plant or plot map, <br />a location map showing major features and facilities in the vtdnuy, the USGS topographic map and FEMA <br />]load map for the site area, and zoninglland use maps, M4M of the conditions can and should be recorded <br />ddirectly on the prosect plan Distances to major fraturer and faciliries (e -g., schools and fin stations) and a <br />esenpaort of the surrounding area are emmplem lite plan can then be referenced as 'source <br />documentation' on form hVD-4428 <br />PI -F -A 5 e Sui5ni r A N mHsokHoop KAP AL-oN(, Wirt# Tris, <br />