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el V. STATE ENVIRONMENTAL POLICY ACT(SEPA) <br /> 1. Has SEPA review been completed? 0 YES D NO Date <br /> 2. Lead agency issuing SEPA Determination: Department of Ecology after application submitted <br /> 3. Type of SEPA Determination: 0 DNS ❑ DS 0 Mitigated DNS <br /> VI. WATERBODY SYSTEM: <br /> 1. Provide the name(s)of major,named receiving water bodies in the treatment area: <br /> Receiving (downstre water): Snohomish River, rt Gardner Bay, North Creek, Swamp Creek. <br /> Treatment Waterbodies: All public and private stormwater control ponds within Everett city limits and the City's <br /> wastewater treatment lagoons. <br /> 2. Is the receiving water a part of a designated critical habitat of a species listed under the Endangered Species <br /> Act(ESA)or is the receiving water in an Evolutionary Significant Unit(ESU)of a species listed under the <br /> ESA? El Yes ❑No <br /> a. If yes, what species? Chinook Salmon/Bull Trout <br /> b. Name the ESU(s): Puget Sound <br /> 3. Water Resource Inventory Area(WRIA)(s) 7 and 8 <br /> 4. City(s) Everett County Snohomish <br /> 5. Attach a map that clearly provides the following information: <br /> a.The treatment area and the boundaries of the Mosquito Control District(MCD)or the treatment area if not <br /> in an MCD. <br /> b. Sections,ranges, and townships of the MCD or treatment area. <br /> c. Latitudes and longitudes of the MCD or treatment area in degrees,minutes and seconds. <br /> d. The location of any areas of concern,including ESA or ESU areas,that have restricted treatment or <br /> prohibited treatment conditions. Identify these in a map key. <br /> VII. CHEMICAL INFORMATION: <br /> 1. Pesticides to be used: <br /> Check all that apply PESTICIDE ESTIMATED AMOUNT TO BE USED. <br /> PER SEASON <br /> Bacillus thuringiensis israelensis <br /> (Bti) <br /> X Bacillus sphaericus(H-5a5b) 2,500 pounds <br /> Methoprene: <br /> • Granular <br /> • Liquid 50,000 briquets <br /> • Pellet <br /> Briquette <br /> Monomolecular surface films <br /> Paraffinic White Mineral oil <br /> Malathion* <br /> Temephos* <br /> rl <br /> -2- <br />