WMOD00395

• Title: Weather Modification Reporting Program - 1973-1978
• Date: 6/1/1979
• Weather Modification - Doc Type: Report

APPENDIX C-l

Complete in accordance with instructions on reverse and forward copy:

TO: Science and Academic Affairs Office (RD-2)
National Oceanic and Atmospheric Administration
Rockvi lie, Maryland 20852

1. PROJECT OR ACTIVITY DESIGNATION, IF ANY

Form Aooroved: OMB No. 41-2664 Exo;res 12-,31-80:

NOAA FORM 17-4 U. S. DEPARTMENT OIF COMMERCE
(12-77) NAT'L OCEANIC AND ATMOSPHERIC ADM.

4.(0) SPONSOR
NAME

INITIAL REPORT ON WEATHER MODIFIC,nION
ACTIVITIES (P.L. 205, 92ND. CONG/;~ESS)
2. DATES OF PROJECT
a. DATE FIRST ACTUAL WEATHER
MODIFICATION ACTIVITY IS TO
BE UNDERTAKEN
b. EXPECTED TERMINATION
DATE OF WEATHER
MODIFICATION ACTIVITIES
4.(b) OPERATOR
NAME

3, PURPOSE OF PROJECT OR ACTIVITY

AFFILIATION

I PHONE NUMBER

AFFILIATION

I PHONE NUMBER

STREET ADDRESS

STREET ADDRESS

CITY

I ZIP CODE CITY

5. TARGET AND CONTROL AREAS (See InstTtlctions)
E CONTROL AREA
\SIZE OF AREA LOCATION rillE OF AREA

SQ. MI. _ L SQ. MI.
6. DESCRIPTION OF WEATHER MODIFICATION APPARATUS, MODIf'ICATION AGENTS AND THEIR DISPERSAL RATES, THE TECHNIQUES
EMPLOYED, ETC. (See Inst,uction.)

rTATE

I STATE

1 ZIF' CODE

TARGET AREA

LOCATION

7. LOG BOOKS,

NAME

Enter name, affiliation. address, and telephone number of
responsible individual from whom log books or other records
may be obtained.

I AFFILIATION
STREET ADDRESS

CITY

I PHONE NUMBER

ISTATE

I ZII' CODE

8. SAFETY AND ENVIRONMENT

DYES D NO Has an Environmental Impact Statement, Federal or. State been filed? If yes, please furnish a copy as
applicable.
DYES 0 NO Have provisions been made to acquire the latest forecasts, advisories, warnings, etc. of the National
Weather Service, Forest Service, or others when issued prior to and during operations? If yes, please
specify on a separate sheet.

DYES D NO Have any safety procedures (operational constraints, provisions for suspension of operation:s,_monitorin~
methods, etc.) and any environmental guidelines -(related to the possible effects of the opera(rons)
been included in the operational plans? [f yes, please furnish copies or a description of the specific
procedures and guidelines.

9. OPTIONAL REMARKS (See Instructions. Uee Separate Sheet.)

NAME

I CERTIFICATIO~I:

I certify that the above statements are true, cO~'plete
and correct to the besr of my knowledge and beheL

AFFILIATION

SIGNATURE

STREET ADDRESS

OFFICIAL TITLE

CITY

I STATE

IZIP CODE

DATE

-T PHONE NUMBER

NOAA FORM 17-4 (12-77)

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