coastal management consistency review formfor federal activities（沿海管理一致性审查formfor联邦活动）（8页）.docVIP

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coastal management consistency review formfor federal activities（沿海管理一致性审查formfor联邦活动）（8页）.doc

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Coastal Management Consistency Review Form for Federal Activities Use of this form, although not mandatory, will facilitate coastal consistency review analysis by the Federal agency and result in submission of sufficient information for comprehensive review by the Department of Energy and Environmental Protection (DEEP) Office of Long Island Sound Programs (OLISP). It is anticipated that submittal of a completed form with indicated supplemental materials will, in most instances, eliminate the need for further information. The form should be used in conjunction with the Reference Guide to Coastal Policies and Definitions (DEEP-OLISP-GUID-200). The Instructions and Guidance for Completing the Federal Coastal Consistency Review Form for Federal Activities (DEEP-OLISP-INST-300) explains how to complete this form and provides several critical definitions and pertinent guidance. Once completed, please submit this form with the appropriate supporting documentation to: CT DEEP-OLISP, 79 Elm Street, Hartford, CT 06106-5127. For further information or assistance in completing this form, please contact us at the address above or by phone at 860-424-3034. Part I: Federal Agency and Contact Identification Agency Name: ????? Mailing Address: ????? City/Town: ????? State: ????? Zip Code: ????? Business Phone: ????? ext. ????? Fax: ????? Agency Contact: ????? Title: ????? E-Mail: ????? Identification of Primary Contact for correspondence if other than Agency Contact noted above: Company Name: ????? Mailing Address: ????? City/Town: ????? State: ????? Zip Code: ????? Business Phone: ????? ext. ????? Fax: ????? Contact Person: ????? Title: ????? E-Mail: ????? Part II: Review Type and Project Title Type of Review (check one): Federal Development Project Negative Determination Other Federal agency activity (specify general type): ????? Project Title or Other Identification: ????? Part III: Other DEEP Involvement with the Project Is any component of this act