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� - -, <br /> � <br /> . � <br /> '_ _ <br /> , <br /> . r�s r�,Yn� ;;� <br /> (].9) Rerrcction. ldill thc propnsal result in an inp�ct upon thc quality <br /> or quan�ity of existinp; recrca[ional opportuni.[ies? ' _ X <br /> Cr.planation: ! <br /> (20) Archeolo�ical/Nistorical. I•1i11 [he proposal result in an alteration <br /> of a significant arclieological or historieal site, structure, ol,ject <br /> or buildin&? — � <br /> Explana[ion: <br /> III. SIGNATURE <br /> I, the undersigned, scate that to the best of my knowledge the abeve inforr:acion is <br /> �rue and coapleCe. IL is understood tL-at the lead agenc� nay i;=thdra�:� any declaratic• of ncn- <br /> si�niftcance thzt it might issue in reliance ❑pon this checklist should there be any misreprese: <br /> CaCion or lack of full disclusure on my part. <br /> Proponent: <br /> IV. DECLAFAT.IOi1 OF RESPO\SIIILE OFFICIAL: <br /> The above described project is a major action with (significant, insignificant) <br /> imnact and (will, will aot) require an Environmen[al Impact Statement. <br /> ResponsibLe Official I <br /> I <br /> I <br /> i <br /> � <br /> I <br />