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ENVIRONMENTAL IMPACT ASSESSMENT

PROJECT IDENTIFICATION

Field Information
Project Name: _________________________________
Project ID/Reference: _________________________________
Project Proponent: _________________________________
Project Location: _________________________________
Assessment Date: _________________________________
Assessment Prepared By: _________________________________
Assessment Reviewed By: _________________________________

EXECUTIVE SUMMARY

Project Overview

[Provide a brief summary of the proposed project, its purpose, and key components]

_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Key Environmental Issues

[Summarize the main environmental issues identified]

Issue Significance Mitigation Feasibility
☐ High ☐ Med ☐ Low ☐ High ☐ Med ☐ Low
☐ High ☐ Med ☐ Low ☐ High ☐ Med ☐ Low
☐ High ☐ Med ☐ Low ☐ High ☐ Med ☐ Low

Overall Assessment

☐ No Significant Impact: Project may proceed with standard controls
☐ Moderate Impact: Project may proceed with mitigation measures
☐ Significant Impact: Project requires substantial mitigation or redesign
☐ Unacceptable Impact: Project should not proceed as proposed

Key Recommendations

  1. _____________________________________________________________________________
  2. _____________________________________________________________________________
  3. _____________________________________________________________________________

SECTION 1: PROJECT DESCRIPTION

1.1 Project Purpose and Need

Purpose:
[Describe why the project is being proposed]

_________________________________________________________________________________
_________________________________________________________________________________

Need:
[Describe the need the project addresses]

_________________________________________________________________________________
_________________________________________________________________________________

1.2 Project Location

Site Description:

Field Information
Address/Coordinates
Total Project Area
Land Use (Current)
Land Use (Proposed)
Zoning
Property Ownership

Site Map:
[Attach site location map showing project boundaries and surrounding area]

1.3 Project Components

Physical Components:

Component Description Size/Capacity

Supporting Infrastructure:

☐ Roads and access
☐ Utilities (power, water, sewer)
☐ Stormwater management
☐ Waste management facilities
☐ Other: _________________________

1.4 Project Activities

Construction Phase:

Activity Duration Equipment/Methods
Site preparation
Excavation
Construction
Commissioning

Operational Phase:

Activity Description Frequency

Decommissioning Phase (if applicable):
[Describe end-of-life activities]

_________________________________________________________________________________

1.5 Project Schedule

Phase Start Date End Date Duration
Planning/Permitting
Construction
Operation
Decommissioning

1.6 Alternatives Considered

Alternative 1: No Action/No Build
[Describe environmental effects if project does not proceed]

_________________________________________________________________________________

Alternative 2: [Description]
[Describe alternative and why it was not selected]

_________________________________________________________________________________

Alternative 3: [Description]
[Describe alternative and why it was not selected]

_________________________________________________________________________________

Preferred Alternative Rationale:
[Explain why the proposed project was selected]

_________________________________________________________________________________

SECTION 2: ENVIRONMENTAL BASELINE

2.1 Physical Environment

2.1.1 Climate

Parameter Value/Description
Average Temperature
Annual Precipitation
Prevailing Winds
Climate Zone
Climate Change Projections

2.1.2 Topography and Geology

Parameter Description
Elevation
Slope
Geology
Soil Types
Seismic Zone
Erosion Potential

2.1.3 Hydrology and Water Resources

Surface Water:

Water Body Type Distance Use/Classification

Groundwater:

Parameter Description
Aquifer
Depth to Groundwater
Groundwater Quality
Drinking Water Source ☐ Yes ☐ No

Watershed:

Parameter Description
Watershed Name
Drainage Area
Impervious Surface

2.1.4 Air Quality

Parameter Baseline Level Attainment Status
PM2.5 ☐ Attainment ☐ Non-attainment
PM10 ☐ Attainment ☐ Non-attainment
Ozone ☐ Attainment ☐ Non-attainment
NOx ☐ Attainment ☐ Non-attainment
SO2 ☐ Attainment ☐ Non-attainment
CO ☐ Attainment ☐ Non-attainment

2.2 Biological Environment

2.2.1 Vegetation

Habitat Type Area Condition Sensitivity
☐ Good ☐ Fair ☐ Poor ☐ High ☐ Med ☐ Low
☐ Good ☐ Fair ☐ Poor ☐ High ☐ Med ☐ Low

Significant Vegetation:
☐ Wetlands
☐ Riparian areas
☐ Old-growth forest
☐ Native grassland
☐ Other sensitive habitats: _________________________

2.2.2 Wildlife

Species Group Common Species Protected/Special Status
Mammals
Birds
Reptiles/Amphibians
Fish
Invertebrates

Protected/Sensitive Species:

Species Status Potential Occurrence
☐ Endangered ☐ Threatened ☐ Special Concern ☐ Confirmed ☐ Likely ☐ Possible
☐ Endangered ☐ Threatened ☐ Special Concern ☐ Confirmed ☐ Likely ☐ Possible

2.2.3 Protected Areas

Protected Area Type Distance Potential Impact

2.3 Socioeconomic Environment

2.3.1 Population and Demographics

Parameter Value
Population (within project area)
Population (surrounding area)
Population Trend
Vulnerable Populations

2.3.2 Land Use

Land Use Type Area Percentage
Residential
Commercial
Industrial
Agricultural
Open Space
Other

2.3.3 Cultural Resources

☐ Archaeological sites identified
☐ Historic structures
☐ Traditional cultural properties
☐ Sacred sites
☐ No significant cultural resources

2.3.4 Indigenous Peoples

☐ Indigenous communities present
☐ Traditional territories affected
☐ FPIC process required
☐ Not applicable

SECTION 3: IMPACT ASSESSMENT

3.1 Impact Assessment Methodology

Methods Used:
☐ Literature review
☐ Field surveys
☐ Modeling (specify): _________________________
☐ Stakeholder consultation
☐ Expert judgment
☐ GIS analysis
☐ Other: _________________________

Significance Criteria:

Factor Criteria
Magnitude Scale of change from baseline
Extent Geographic area affected
Duration Temporary, short-term, long-term, permanent
Reversibility Ability to return to baseline
Probability Likelihood of occurrence
Sensitivity Receptor vulnerability

3.2 Air Quality Impacts

Construction Phase:

Source Pollutant Impact Level Duration
Dust generation PM ☐ High ☐ Med ☐ Low Temporary
Equipment exhaust NOx, CO, PM ☐ High ☐ Med ☐ Low Temporary

Operational Phase:

Source Pollutant Impact Level Duration
☐ High ☐ Med ☐ Low
☐ High ☐ Med ☐ Low

Cumulative Impacts:
[Assess in context of other projects/sources]

_________________________________________________________________________________

3.3 Water Resource Impacts

Surface Water:

Impact Phase Significance Mitigation
Sediment runoff Construction ☐ High ☐ Med ☐ Low
Stormwater quality Operation ☐ High ☐ Med ☐ Low
Flow alteration Operation ☐ High ☐ Med ☐ Low

Groundwater:

Impact Phase Significance Mitigation
Contamination risk ☐ High ☐ Med ☐ Low
Dewatering impacts ☐ High ☐ Med ☐ Low
Recharge reduction ☐ High ☐ Med ☐ Low

3.4 Noise Impacts

Construction Phase:

Source Noise Level (dBA) Receptor Impact Level
☐ High ☐ Med ☐ Low
☐ High ☐ Med ☐ Low

Operational Phase:

Source Noise Level (dBA) Receptor Impact Level
☐ High ☐ Med ☐ Low
☐ High ☐ Med ☐ Low

3.5 Soil and Land Impacts

Impact Area Affected Significance Reversibility
Soil disturbance ☐ High ☐ Med ☐ Low ☐ Yes ☐ Partial ☐ No
Erosion ☐ High ☐ Med ☐ Low ☐ Yes ☐ Partial ☐ No
Contamination risk ☐ High ☐ Med ☐ Low ☐ Yes ☐ Partial ☐ No
Habitat loss ☐ High ☐ Med ☐ Low ☐ Yes ☐ Partial ☐ No

3.6 Biodiversity Impacts

Habitat:

Habitat Type Area Affected Significance Duration
☐ High ☐ Med ☐ Low
☐ High ☐ Med ☐ Low

Species:

Species/Group Impact Type Significance Mitigation
☐ High ☐ Med ☐ Low
☐ High ☐ Med ☐ Low

Protected Species Assessment:
☐ No protected species affected
☐ Protected species may be affected (specify): _________________________
☐ Consultation with wildlife agencies required

3.7 Climate and GHG Impacts

GHG Emissions:

Source Phase Emissions (tCO2e/yr) Significance
Construction ☐ High ☐ Med ☐ Low
Operation ☐ High ☐ Med ☐ Low

Climate Vulnerability:

Climate Risk Relevance Project Resilience
Sea level rise ☐ High ☐ Med ☐ Low ☐ N/A
Flooding ☐ High ☐ Med ☐ Low ☐ N/A
Drought ☐ High ☐ Med ☐ Low ☐ N/A
Extreme heat ☐ High ☐ Med ☐ Low ☐ N/A
Storms ☐ High ☐ Med ☐ Low ☐ N/A

3.8 Socioeconomic Impacts

Impact Positive/Negative Significance Duration
Employment ☐ Positive ☐ Negative ☐ High ☐ Med ☐ Low
Local economy ☐ Positive ☐ Negative ☐ High ☐ Med ☐ Low
Traffic ☐ Positive ☐ Negative ☐ High ☐ Med ☐ Low
Visual/Aesthetic ☐ Positive ☐ Negative ☐ High ☐ Med ☐ Low
Property values ☐ Positive ☐ Negative ☐ High ☐ Med ☐ Low
Community character ☐ Positive ☐ Negative ☐ High ☐ Med ☐ Low

3.9 Cultural Resource Impacts

☐ No cultural resources affected
☐ Cultural resources may be affected (specify): _________________________
☐ Consultation with relevant authorities required
☐ Archaeological survey required
☐ Mitigation plan required

3.10 Cumulative Impacts

Past, Present, and Reasonably Foreseeable Projects:

Project Type Status Cumulative Effects
☐ Past ☐ Present ☐ Future
☐ Past ☐ Present ☐ Future

Cumulative Impact Assessment:

Resource Cumulative Impact Significance
Air quality ☐ High ☐ Med ☐ Low
Water quality ☐ High ☐ Med ☐ Low
Habitat/biodiversity ☐ High ☐ Med ☐ Low
GHG emissions ☐ High ☐ Med ☐ Low

SECTION 4: IMPACT SUMMARY MATRIX

Environmental Factor Construction Operation Decommissioning Cumulative
Air Quality ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ -
Water Resources ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ -
Noise ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ -
Soil/Land ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ -
Biodiversity ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ -
Climate/GHG ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ -
Socioeconomic ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ -
Cultural Resources ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ - ☐ + ☐ 0 ☐ -

(+ = Positive, 0 = Neutral/Negligible, - = Negative)

SECTION 5: MITIGATION MEASURES

5.1 Mitigation Hierarchy

Mitigation follows the hierarchy of:
1. Avoid - Eliminate impacts through design changes
2. Minimize - Reduce impacts that cannot be avoided
3. Restore - Rehabilitate affected areas
4. Offset - Compensate for residual impacts

5.2 Mitigation Plan

Impact Mitigation Measure Responsible Party Timeline Residual Impact
☐ High ☐ Med ☐ Low ☐ Negligible
☐ High ☐ Med ☐ Low ☐ Negligible
☐ High ☐ Med ☐ Low ☐ Negligible
☐ High ☐ Med ☐ Low ☐ Negligible
☐ High ☐ Med ☐ Low ☐ Negligible

5.3 Best Management Practices

Construction BMPs:
☐ Erosion and sediment control plan
☐ Dust suppression measures
☐ Spill prevention and response
☐ Noise and vibration controls
☐ Traffic management plan
☐ Waste management plan

Operational BMPs:
☐ Stormwater management
☐ Pollution prevention
☐ Energy efficiency measures
☐ Water conservation
☐ Waste minimization

SECTION 6: MONITORING PLAN

6.1 Environmental Monitoring

Parameter Location Frequency Method Responsible

6.2 Compliance Monitoring

Requirement Monitoring Method Frequency Reporting

6.3 Adaptive Management

[Describe how monitoring results will be used to adjust mitigation measures]

_________________________________________________________________________________
_________________________________________________________________________________

SECTION 7: STAKEHOLDER CONSULTATION

7.1 Consultation Activities

Stakeholder Group Date Method Key Issues Raised
☐ Meeting ☐ Survey ☐ Public hearing
☐ Meeting ☐ Survey ☐ Public hearing
☐ Meeting ☐ Survey ☐ Public hearing

7.2 Response to Concerns

Concern Response/Mitigation

SECTION 8: CONCLUSIONS AND RECOMMENDATIONS

8.1 Conclusions

[Summarize key findings and overall assessment]

_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

8.2 Recommendations

Design Modifications:
1. _____________________________________________________________________________
2. _____________________________________________________________________________

Mitigation Requirements:
1. _____________________________________________________________________________
2. _____________________________________________________________________________

Monitoring Requirements:
1. _____________________________________________________________________________
2. _____________________________________________________________________________

Permit Requirements:
1. _____________________________________________________________________________
2. _____________________________________________________________________________

8.3 Assessment Determination

☐ Finding of No Significant Impact (FONSI): The project, with proposed mitigation, will not have significant environmental impacts.

☐ Environmental Impact Statement (EIS) Required: Significant impacts are likely; a full EIS is recommended.

☐ Conditional Approval: The project may proceed with the following conditions:
_________________________________________________________________________________

☐ Not Recommended: The project should not proceed as proposed due to:
_________________________________________________________________________________

CERTIFICATION

I certify that this Environmental Impact Assessment has been prepared in accordance with applicable standards and that the information contained herein is accurate to the best of my knowledge.

Prepared By:

Signature: _________________________________

Printed Name: _____________________________

Title/Qualifications: _________________________

Date: ____________________________________

Reviewed By:

Signature: _________________________________

Printed Name: _____________________________

Title/Qualifications: _________________________

Date: ____________________________________

Project Proponent Acknowledgment:

Signature: _________________________________

Printed Name: _____________________________

Title: ____________________________________

Date: ____________________________________

APPENDICES

Appendix A: Site Maps and Figures

Appendix B: Technical Studies and Data

Appendix C: Stakeholder Consultation Records

Appendix D: Regulatory Correspondence

Appendix E: Species Lists

Appendix F: Mitigation Plan Details

Appendix G: Monitoring Plan Details

NOTICE: This template is provided for informational purposes only and does not constitute legal advice. Environmental impact assessment requirements vary by jurisdiction and project type. Organizations should consult with qualified environmental professionals and legal counsel to ensure compliance with applicable federal, state, and local requirements. The NEPA regulatory framework has undergone significant changes in 2025, and agencies now have individual implementation procedures.

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ENVIRONMENTAL IMPACT ASSESSMENT

GENERAL TEMPLATE

Effective Date: [DATE]
Party A: [PARTY A NAME]
Address: [PARTY A ADDRESS]
Party B: [PARTY B NAME]
Address: [PARTY B ADDRESS]
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This document is entered into by and between [PARTY A NAME] and [PARTY B NAME], effective as of the date set forth above, subject to the terms and conditions outlined herein and the laws of [GOVERNING STATE].
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