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Appendix 6. Sample Department of
Transportation Federal Aviation
Administration Categorical Exclusion
Declaration
(Facility/Airport)
(Title of
Proposed Action)
Description of
Action:
From the Initial
Environmental Review, summarize the
description of the action, and the
purpose and need.
Declaration of
Exclusion: The FAA has reviewed
the above referenced proposed action
and it has been determined, by the
undersigned, to be categorically
excluded from further environmental
documentation according to FAAO
1050.1E, “Environmental Impacts:
Policies and Procedures." The
implementation of this action will
not result in any extraordinary
circumstances in accordance with
FAAO 1050.1E.
Basis for this
Determination: An Initial
Environmental Review was conducted
by __________ (INSERT the facility
name) and reviewed by the
____________ (INSERT the Terminal,
or En Route & Oceanic Operations
Service Area where Environmental
Specialist is located). This review
was conducted in accordance with
policies and procedures in
Department of Transportation Order
5610.1C, “Procedures for Considering
Environmental Impacts" and FAAO
1050.1E.
The applicable
categorical exclusion is:
____________ (INSERT a description
of the appropriate CATEX with FAAO
1050.1E paragraph reference here).
Recommended by:
______________________________ Date:
__________________
(Name - Title of
Facility Manager)
Concurrence:
______________________________
Date:___________________
(Name - Service
Area Environmental Specialist)
Approved by:
______________________________
Date:___________________
(Name - Service
Area Director (or Designee)) |
