NEPA GREEN SHEET CERTIFICATION

TO:	HQ Environmental Division, TDOT.Env.NEPA@tn.gov

FROM:

DATE:	Click here to enter a date.

SUBJECT:	County:

PIN:

Project NO.:

Project Description:

I certify that the roadway plans include all items from the attached environmental “green sheet” other than those noted below.

Explanation:

____________________________	__________________________	__________________

Name	Title (Project Development)	Date

I certify that the roadway design plans for this project have been reviewed by Environmental Division staff and that all items shown on the attached green sheet, other than any items specifically explained above, are included in the plans.

___________________________	__________________________	__________________

Name	Title (Environmental Division)	Date

Attachment