Development Name:       

Aircraft Noise (if within 5 miles of an airfield)

1.	
Acronym Key
NEF: Noise Exposure Forecasts
CNEL: Community Noise Equivalent Level (CA only)
DNL: Day–Night Average Sound Level	
NAL: Noise Assessment Location
CNR: Composite Noise Rating
ADT: Average Daily Traffic

List all Civil Airports within 5 miles of site or Military Airports within 15 miles. Municipal airports without jet operations do not need to be listed:
a.	     
b.	     
c.	     

2.	If DNL, NEF or CNR noise contours are available, is the site located within any contours?
     

3.	What is the highest noise contour that the site is located within?
     

If there are no noise contours available, answer the following:

4.	Number of nighttime jet operations? 	     
                                                    Projected?		     

5.	Number of daytime jet operations?		     
                                                   Projected?	     

6.	Operations data for what year?		     

7.	Operations projected to what year?	     

	     	
	Source of Information 	

	     	
	Preparer’s Name and Organization	

Railway Noise (if within 3000 feet of a railroad)

1.	List all Railways within 3000 feet of site:
Train A:	     
Train B:	     
Train C:	     

2.	Distance in feet from the NAL to the railway track:
Train A:	     
Train B:	     
Train C:	     

3.	Number of trains in 24 hours:
Train A:	Diesel	     
Electric	     
Train B:	Diesel	     
Electric	     
Train C:	Diesel	     
Electric	     

4.	Percentage of operations occurring at night (10 p.m.-7 a.m.):
Train A:	     
Train B:	     
Train C:	     

5.	Number of diesel locomotives per train:
Train A:	     
Train B:	     
Train C:	     

6.	Number of rail cars per train:
Train A:	Diesel	     
Electric	     
Train B:	Diesel	     
Electric	     
Train C:	Diesel	     
Electric	     

7.	Average train speed:
Train A:	     
Train B:	     
Train C:	     

8.	Is track welded or bolted?
Train A:	     
Train B:	     
Train C:	     

9.	Are whistles or horns required for grade crossing?
Train A:	     
Train B:	     
Train C:	     

	     	
	Source of Information 	

	     	
	Preparer’s Name and Organization	
	     	
	Source of Information 	

	     	
	Preparer’s Name and Organization	

Roadway Noise (if within 1000 feet of highway, freeway or heavily traveled road)

1.	List all major Roads within 1000 feet of site. A major road is defined as having at least 10,000 vehicles in average daily traffic.  
Roadway A:		     
Roadway B:		     
Roadway C:		     

2.	Distance in feet from the NAL to the edge of the road:
Roadway A:
a.	Nearest lane?	     
b.	Farthest lane?	     
c.	Average?	     

Roadway B:
a.	Nearest lane?	     
b.	Farthest lane?	     
c.	Average?	     

Roadway C:
a.	Nearest lane?	     
b.	Farthest lane?	     
c.	Average?	     

3.	Distance to stop signs?
Roadway A:		     
Roadway B:		     
Roadway C:		     

4.	Road gradient in percent (.xx)?
Roadway A:		     
Roadway B:		     
Roadway C:		     

5.	Average speed in mph:
Roadway A:
a.	Autos?	     
b.	Heavy trucks - uphill?	     
c.	Heavy trucks - downhill?	     

Roadway B:
a.	Autos?	     
b.	Heavy trucks - uphill?	     
c.	Heavy trucks - downhill?	     

Roadway C:
a.	Autos?	     
b.	Heavy trucks - uphill?	     
c.	Heavy trucks - downhill?	     
6.	
Auto ADT (data and projected):
Roadway A:
a.	Autos	     
b.	Medium trucks	     
c.	Effective ADP	     

Roadway B:
a.	Autos	     
b.	Medium trucks	     
c.	Effective ADP	     

Roadway C:
a.	Autos	     
b.	Medium trucks	     
c.	Effective ADP	     

7.	Heavy truck ADT (data and projected):
Roadway A:
a.	Uphill or total	     
b.	Downhill	     
c.	Buses	     
d.	TOTAL		     

Roadway B:
a.	Uphill or total	     
b.	Downhill	     
c.	Buses	     
d.	TOTAL		     

Roadway C:
a.	Uphill or total	     
b.	Downhill	     
c.	Buses	     
d.	TOTAL		     

8.	Fraction of nighttime traffic (10 p.m.-7 a.m.)?
Roadway A:		     
Roadway B:		     
Roadway C:		     

9.	Traffic data for what year?      

10.	Traffic projected to what year?      

11.	Growth rate %/yr (as a whole)?      

	     	
	Source of Information 	

	     	
	Preparer’s Name and Organization