CDOT Form 128B "Nepa Determination / Project Certification" - Colorado

What Is CDOT Form 128B?

This is a legal form that was released by the Colorado Department of Transportation - a government authority operating within Colorado. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 21, 2016;
  • The latest edition provided by the Colorado Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of CDOT Form 128B by clicking the link below or browse more documents and templates provided by the Colorado Department of Transportation.

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Download CDOT Form 128B "Nepa Determination / Project Certification" - Colorado

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Colorado Department of Transportation
NEPA DETERMINATION / PROJECT CERTIFICATION
A. PROJECT INFORMATION
Form:
Environmental Scoping Date:
Project #:
Subaccount #:
Related Subaccount #:
Project Name:
Project Description
(and Location):
Region:
CDOT Program/Residency:
Environmental PM:
FHWA Area Engineer:
Project Lead:
FHWA NEXUS
Yes
Other Federal NEXUS:
Yes
CDOT
Local Agency
Other
No
No
Class of Action:
Construction/Contracting Method:
CatEx
Design-Bid-Build
Design Build
EIS/ROD
EA/FONSI
If CatEx, the project fits the following CE number:
GM/GC
Other:
B. THE NEPA PROCESS
Resource Clearances
Revised Clearances
Check Box Only if Impacted
Clearance Date
Revised Clearance date
Revised Clearance date
Air Quality (hot spot analysis)
Noise
Hazmat - ISA/MESA
T&E and State Listed Species
Wetland Delineation (Survey)
Paleontology
Archaeology
History
Section4(f) - Historic
Section4(f) - Non-Historic
Section6(f)
Other:
All required clearance actions indicated have been completed for the
All required clearance actions indicated have been completed for the
design plans referenced below. If Project is a Categorical Exclusion, no
design plans referenced below. If Project is a Categorical Exclusion, no
significant environmental impacts will result from this project. Construction
significant environmental impacts will result from this project. Construction
is not authorized until approved in Part E below. Implementation of project
is not authorized until approved in Part E below. Implementation of project
shall include required mitigation commitments.
shall include required mitigation commitments.
FHWA signature is not required because:
Action meets requirements to be a Programmatic CatEx per the
FHWA/CDOT Programmatic Agreement for Categorical Exclusions
(FHWA signature below not required).
This is a Programmatic CatEx
This is a Programmatic CatEx
This is a Reevaluation of an
This is a Reevaluation of an
This is an EA/FONSI or EIS/ROD. The Decision Document has
EA/FONSI or EIS/ROD (1399
EA/FONSI or EIS/ROD (1399
already been signed by FHWA (FHWA signature below is not required).
form has already been signed.)
form has already been signed.)
/
/
/
Design Plan Set and Date:
RPEM Signature and Date:
/
/
/
FHWA Division Administrator Signature (if required)
FHWA Division Administrator Signature (if required)
I concur with the above category designation and the scope of environmental
I concur with the above category designation and the scope of environmental
clearance/permits indicated above.
clearance/permits indicated above.
Signature and Date:
/
/
/
Comments:
Colorado Department of Transportation
NEPA DETERMINATION / PROJECT CERTIFICATION
A. PROJECT INFORMATION
Form:
Environmental Scoping Date:
Project #:
Subaccount #:
Related Subaccount #:
Project Name:
Project Description
(and Location):
Region:
CDOT Program/Residency:
Environmental PM:
FHWA Area Engineer:
Project Lead:
FHWA NEXUS
Yes
Other Federal NEXUS:
Yes
CDOT
Local Agency
Other
No
No
Class of Action:
Construction/Contracting Method:
CatEx
Design-Bid-Build
Design Build
EIS/ROD
EA/FONSI
If CatEx, the project fits the following CE number:
GM/GC
Other:
B. THE NEPA PROCESS
Resource Clearances
Revised Clearances
Check Box Only if Impacted
Clearance Date
Revised Clearance date
Revised Clearance date
Air Quality (hot spot analysis)
Noise
Hazmat - ISA/MESA
T&E and State Listed Species
Wetland Delineation (Survey)
Paleontology
Archaeology
History
Section4(f) - Historic
Section4(f) - Non-Historic
Section6(f)
Other:
All required clearance actions indicated have been completed for the
All required clearance actions indicated have been completed for the
design plans referenced below. If Project is a Categorical Exclusion, no
design plans referenced below. If Project is a Categorical Exclusion, no
significant environmental impacts will result from this project. Construction
significant environmental impacts will result from this project. Construction
is not authorized until approved in Part E below. Implementation of project
is not authorized until approved in Part E below. Implementation of project
shall include required mitigation commitments.
shall include required mitigation commitments.
FHWA signature is not required because:
Action meets requirements to be a Programmatic CatEx per the
FHWA/CDOT Programmatic Agreement for Categorical Exclusions
(FHWA signature below not required).
This is a Programmatic CatEx
This is a Programmatic CatEx
This is a Reevaluation of an
This is a Reevaluation of an
This is an EA/FONSI or EIS/ROD. The Decision Document has
EA/FONSI or EIS/ROD (1399
EA/FONSI or EIS/ROD (1399
already been signed by FHWA (FHWA signature below is not required).
form has already been signed.)
form has already been signed.)
/
/
/
Design Plan Set and Date:
RPEM Signature and Date:
/
/
/
FHWA Division Administrator Signature (if required)
FHWA Division Administrator Signature (if required)
I concur with the above category designation and the scope of environmental
I concur with the above category designation and the scope of environmental
clearance/permits indicated above.
clearance/permits indicated above.
Signature and Date:
/
/
/
Comments:
Colorado Department of Transportation
NEPA DETERMINATION / PROJECT CERTIFICATION
Text
C. PERMITS AND ADDITIONAL REQUIREMENTS
Form: 01
Resource Clearances
Revised Clearances
Check Box Only if Impacted
Date Completed
Date Updated
Date updated
404 Permit
401 Certification
402 Certification
Const. Stormwater Permit (CDPS)
Const. Dewatering Permit
Noxious Weed Management
SB40 Certification
Wetland Finding
Structure Demolition Permit
Hazardous Materials – Phase II
Permanent WQ
SWMP
Other:
D. Comments
E. ENVIRONMENTAL PROJECT CERTIFICATION
All clearance and permit requirements for this project have been addressed and mitigation included. The appropriate documentation is on
file in the Region office.
Revised Clearance
Revised Clearance
Clearance
Design Plan Set and Date:
/
/
/
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Certification Type:
Advertisement & Construction
Advertisement & Construction
Advertisement & Construction
Other:
Other:
Other:
RPEM Signature & Date:
/
/
/
Note to Project Manager: Any changes to the plans and specifications after the date of the RPEM signature in Part B that affect environmental impacts or
mitigation must be approved by the RPEM.
Distribution:
original
RPEM (
): copies to Project Manager, Right of way (if ROW required)
CDOT Form #128b (07/21/2016)
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