Applicable Agency Date Date Section of ? Sent Exhibit G, (Y/N) (Y/N) Review Worksheet 2-1-1 Local Unit of Government - Zoning IN-DNR Lake Michigan Coastal – 2-1-2 Program Indiana Department of 2-1-3 Environmental Management (IDEM) U.S. Environmental Protection 2-2 Agency USDA - Natural Resources 2-3 Conservation Service 2-5 IN-DNR Water – 3-4-1 IDEM Office of Air Quality – 3-5-2 IN-DNR Fish and Wildlife – 3-6-4 Indian Tribes 4-4 Indiana Geological Survey Local Soil and Water Conservation 4-4 District Other: Other: Other: Other: Other: Other: name project name application #_____________________ FINDINGS must be completed for both Categorically Excluded (Subject to 58.5) and Assessed Projects. 1.Summary of Environmental Conditions: 2. Summary of Findings and Conclusions: 3. Conditions and Requirements
Applicable Section of Exhibit G, Review Worksheet Agency (Y/N) Date Sent Date (Y/N) 2-1-1 Local Unit of Government - Zoning 2-1-2 IN-DNR – Lake Michigan Coastal Program 2-1-3 Indiana Department of Environmental Management (IDEM) 2-2 U.S. Environmental Protection Agency 2-3 USDA - Natural Resources Conservation Service 2-5 IN-DNR – Water 3-4-1 IDEM – Office of Air Quality 3-5-2 IN-DNR – Fish and Wildlife 3-6-4 Indian Tribes 4-4 Indiana Geological Survey 4-4 Local Soil and Water Conservation District Other: Other: Other: Other: Other: Other: name project name application #_____________________ FINDINGS must be completed for both Categorically Excluded (Subject to 58.5) and Assessed Projects. 1.Summary of Environmental Conditions: 2. Summary of Findings and Conclusions: 3. Conditions and Requirements ?