Dist-Co-Rte-KP-E.A.

Fact Sheet
EXCEPTION TO
PSR(PDS) REQUIREMENT

For STIP or SHOPP Projects with EIS or ND Environmental Documents

Project Description:

Briefly describe the project; what is the proposal? Note the type of project and/or major elements of work to be done, such as safety or operational improvement, roadway widening, rehabilitation, reconstruction, etc. Provide the geographic project limits and length; i.e. "…On Route 12 in Sonoma County between Napa St. (KP 60.7, PM 37.7) and Napa Rd. (KP 62.3, PM 38.7)".

Reason for Requesting Exception:

Be thorough, but brief; justification must be as complete and as convincing as possible in answering why a Project Study Report should be utilized as the project initiation document rather than a Project Study Report (Project Development Support).

Proposed Program Year:

List anticipated fiscal year that construction funding will be programmed.

Proposed Schedule:

Approve PSR:_______ PA&ED:________ PS&E:________ RTL:_______
List anticipated milestone dates

Project Manager: .. name

.phone #:

Recommended for Approval:
_________________signature___________________
_________
 

(Name) Chair, District Change Control Team

date


Approval By:
_________________signature___________________
_________
 
(Name) Project Development Coordinator
date

*Note: If exception is approved, the following conditions apply to the PSR:

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