CERTIFICATION OF ENVIRONMENTAL SITE ASSESSMENT FAA Central Region To: Manager, Safety and Standards Branch Subject: AIP Project No.: Parcel No(s).: Owner: Airport
This certification is made to satisfy the requirements for an Environmental Site Assessment. Said Airport has completed the following action: ---------------------------------------------------------------------------------------------------------------------------------------- Phase One Environmental Site Assessment Performed by Environmental Specialist:
(Name)
(Name of Firm)
Date of Said Report Findings of this practice: - no need for further inquiry - need for further inquiry - proceed to full Phase II (Need FAA Concurrence) ---------------------------------------------------------------------------------------------------------------------------------------
SPONSOR’S STATEMENT OF CERTIFICATION: The (Sponsor), hereby certifies that based upon a diligent investigation of potential liability from each parameter discussed in this report, it is determined that the risk for incurring environmental liability is very low. Therefore, it is not necessary to continue on to the Phase Two ESA.
(Signature)
(Title of Sponsor Official)
(Date)