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DEr'AkTMENT OF TRANSPORTATION - FEDERAL AVIATION ADMINISTRATION <br />PART It <br />PROJECT APPROVAL INFORMATION <br />SECTION A <br />Item 1. <br />Does this assistance request require State, local, Name of Governing Body <br />regional, or other priority rating? Priority Rating <br />Yes X_ No <br />Item 2. <br />Does this assistance request require State, or local Name of Agency or <br />advisory, educational or health clearances? Board <br />X <br />Yes No (Attach Documentation) <br />Item 3. <br />Does this assistance request require clearinghouse review (Attach Comments) <br />in accordance with OMB Circular A -95? <br />x Yes No supplied Previously <br />Item 4. <br />Does this assistance request require State, local, <br />regional or other planning approval? <br />Name of Approving Agency <br />Dote <br />228 <br />OMB NO. 80 -no <br />Yes X No <br />Item 5. ` <br />is the proposed project covered by an approved Check one: State C' f <br />comprehensive pion? Local . I. <br />Regional C_ I <br />Yes X No Location of plan <br />Item 6. <br />Will the assistance requested serve a Federal Nome of Federal Installation <br />installation? Yes X No Federal Population benefiting from Project <br />Item 7. <br />Will the assistance requested be on Federal land <br />Nome of Federal Installation <br />or installation? <br />Location of Federal Land <br />Yes X <br />No Percent of Project <br />Item 8. <br />Will the assistance requested have an impact or effect <br />See instruction for additional information to be <br />an the environment? <br />provided. <br />Yes X <br />No <br />Item 9. <br />Number of: <br />Will the assistance requested cause the displacement of <br />Individuals <br />individuals families, businesses, or forms? <br />Families <br />Businesses <br />Yes X <br />No Farms <br />,-- Item 10. <br />Is there other related Federal assistance on this <br />See instructions for additional information to be <br />project previous, pending, or anticipated? <br />provided. <br />Yes No <br />FAA Form 51()0_100 (6 -73) SUPERSEgES FAA FORM 5100 -10 PAGES t THRU 7 Page 2 <br />7 <br />I <br />