U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL AVIATION ADMINISTRATION

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(s) is/are: ____________ (INSERT a description of the appropriate CATEX(s) with FAAO 1050.1E paragraph reference(s) 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))