Green Sheet #__

Status of Project Commitments

Project No.

Control No.

Location:

404 Permit Required / Yes / Received: / Permit No.
No / Acres Impacted: Acres Mitigated:
Location:
Project Mitigation Ratio:

Comments: **Indicate whether the permit is notifying or non-notifying.**

Individual 401 Water Quality Certification Required / Yes / Received:
No

Comments:

State Title 117 Waters Required
(COE Non-Jurisdictional) / Yes / Received: / Permit No.
No / Acres Impacted: Acres Mitigated:
Location:
Project Mitigation Ratio:

Comments:

Floodplain Permit Required / Yes / Received: / Permit No.
No

Comments:

Historic Clearance / Yes / Received:
No

Comments:

Threatened & Endangered Species
Clearance Required / Yes / Received: / FHWA –
NGPC –
No / USFWS –

Comments:

NEPA Environmental Clearance / Yes / Received: **Include the document type (ex. CE Level 1, EA, etc.)**
N/A

Comments:

NPDES/Stormwater Permit No.:
Special Provisions: See attached Commitment sheet
Special Notes on Plans:

I have compared environmental documentation, final project plans, and project correspondence with environmental commitments shown on this form and found them to be accurate and complete.

TRU UH ______T&E PM ______EDU UH ______EDU PM ______RSU UH ______TRU PM ______LPS PM ______LPS UH______

(Initial) (Date) (Initial) (Date) (Initial) (Date) (Initial) (Date) (Initial) (Date) (Initial) (Date) (Initial) (Date) (Initial) (Date)


Project Commitments

Control No.: / Project No.:
Project Name:

Below are the Conservation Conditions that will be required for this project. All conditions and regulations of any permit obtained for this project will be followed by the contractor.

(Responsible Party for the measure is found in parentheses)

Commitment

Wetlands and Waters of the United States:

Contact Person: / , Highway Environmental Biologist, (402) 479-

Threatened and Endangered Species:

Contact Person: / , Highway Environmental Biologist, (402) 479-

National Environmental Policy Act:

Contact Person: / , Highway Environmental Biologist, (402) 479-

Distribution List:

Name / Date Sent
Project Manager
Design Manager
Environmental Consultant
District Engineer
District Construction Engineer
District Environmental Liaison
Construction Project Manager
Environmental Permits Unit
Stormwater/Erosion Control Unit / Ron Poe
Environmental Documents Unit
Contract Lettings / Heather Silver
Information Processing / Susie Kalkwarf
Bridge
Right-of-Way
Highway Archeology
FHWA
Maintenance
Other

Additional Comments

D1 – Alison Krohn

D2 – Steve Rader

D3 – Scott Brummond

D4 – Trudy Soll

D5 – Rick Schmunk

D6 – Jason Nichols

D7 –Devlin Reece

D8 – Jason Lehn

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