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application for long-term loan or guarantee - Export-Import Bank of ...

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OMB No. 3048-0013LONG-TERM LOAN OR GUARANTEE APPLICATION Expires 4-30-2010ATTACHMENT B: Environmental Screening DocumentMust Accompany All Applications F<strong>or</strong> Long-Term Financial Supp<strong>or</strong>tThe in<strong>f<strong>or</strong></strong>mation provided on this <strong>f<strong>or</strong></strong>m is used to environmentally categ<strong>or</strong>ize the <strong>application</strong> and thereby de<strong>term</strong>ine thein<strong>f<strong>or</strong></strong>mation needed (if any) <strong>f<strong>or</strong></strong> Ex-Im <strong>Bank</strong> to evaluate the environmental effects <strong>of</strong> the transaction, a process that iscrucial to the appropriate and timely review <strong>of</strong> your <strong>application</strong>. Please check the boxes that apply.Are the products <strong>or</strong> services covered in your <strong>application</strong> destined <strong>f<strong>or</strong></strong> an identified project?No, explain ___________________________________________________________________Yes, a) identify the project______________________________________________________ __b) provide a brief description, including output, capacity, size, etc.____________________ ___________________________________________________________________________________________________________________________________________________________________________________________________________________________c) indicate whether new project, rehabilitation <strong>or</strong> expansion _____________________________Revised 1/07Project LocationIs the project located in <strong>or</strong> near an environmentally sensitive site <strong>or</strong> area? (Check all applicable):Tropical F<strong>or</strong>estNationally Designated Wetlands <strong>or</strong> Seash<strong>or</strong>e / Protected Wildlands / Nationally Designated RefugesNational ParksC<strong>or</strong>al Reefs <strong>or</strong> Mangrove SwampsHabitat <strong>of</strong> Endangered SpeciesLocation affecting indigenous <strong>or</strong> tribal populationsLocation having Hist<strong>or</strong>ical / Archaeological SignificanceLarge Scale Resettlement? (Potential Number <strong>of</strong> People Affected: ____________________)Properties on the W<strong>or</strong>ld Heritage ListProject Sect<strong>or</strong> Or IndustryCheck classification(s) describing the project <strong>f<strong>or</strong></strong> which the exp<strong>or</strong>ts are destined:Large infrastrucure:Airp<strong>or</strong>tP<strong>or</strong>ts/harb<strong>or</strong>sPipelinesHighwaysOther large infrastructure Agro-industries – large scaleF<strong>or</strong>estryMining & Mineral Processing PlantOil & gas field developmentHydropower Plant / Water ReservoirThermal power plantover 140 MWeunder 140 MWeNuclear power plantGeothermal PowerWaste managementIron & Steel Plant Smelter Pulp & Paper PlantPetroleum Refinery <strong>or</strong> Petrochemical Plant Chemical / Pharmaceutical Natural Gas Liquefaction PlantsIndustrial plants – large scaleTransp<strong>or</strong>tation (Aircraft, Locomotives, Boats)Telecommunications <strong>or</strong> SatellitesAir traffic control <strong>or</strong> navigational aidsRailway signalingHospitals and medical equipmentPre-project services, feasibility/environmental studyConsulting servicesOther, specify:_____________________________Name <strong>of</strong> Applicant ______________________________________ Date__________________F<strong>or</strong> inquiries and in<strong>f<strong>or</strong></strong>mation please contact the Engineering & Environment Division at (202)565-3570.

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