Initial GEPA Evaluation Form
| Project No. : | _________________________________________________________ |
| Project Name: | _________________________________________________________ |
| Institution: | _________________________________________________________ |
| Date of Assessment: |
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| Brief Project Description: |
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_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ |
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(Sign one statement. Print or type name, organization, and title below signature.)
Having reviewed this proposed project and the Environmental Checklist, there are no significant adverse environmental effects resulting from this project.
Or |
__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ |
Having reviewed this proposed project and the Environmental Checklist, there may be significant adverse environmental effects resulting from this project. These potential adverse environmental effects are referenced on the Checklist and are further described by the attached narrative.
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__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ |