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�Cs f•it;yl�. l�o <br /> . . • �(�� ;:L!))"I.1 l:�;li.CL" (I1-il ',i1:1�10.� __ ___" �1 <br /> (J') So).i.ci ��a�tc nnd disposa).? .-- --- -L� <br /> lixplarat5.on: _ ---- --- <br /> (1') lit�ruan lii�:i7.t1�. S•;i.).]. i:he proi�osal <br /> rc�.ul+_ i�i tllc creai:ion oi an�� <br /> hctiJ.th :iazard or pot.ential health <br /> Iiazard (:�xcludin9 mental health) ? �_ � <br /> • li>:p].anai�i.on: _ —_---- — <br /> (lEi) n��-t�,�ti�:>. �aiii tl�e prot�o>a]. re- <br /> yult i.n tlie obstruci:ion of any <br /> scenic vi�ta oi: vic�a open to thc <br /> publi.c, or ta5.11 the pr.oposal rc- <br /> sult it� the creation oi an acsL-hc- <br /> tically offensive site open to r\� <br /> publi.c vieto? _ �\ <br /> )3xpinnation: ' -- <br /> (�.9) Recreation, t•:i7.1 ihe proposal re- <br /> sult in an impaci� upon L-he quality <br /> or quantit1� of exisL•i�ig recrea- � <br /> tional opportunii:ies? � <br /> Lxpianacion: ______ � <br /> (201 Archeologica]./Ilisto.rica7.. Wi11 the I <br /> proposal resul.t in an alteration of <br /> a signi.iicant' archeo].ogi.cal or his- ' <br /> Cori.cal sii:e, structure, object or �( <br /> bui.ldiny? _ !\ <br /> �xplanation: <br /> ' III, SIGNA'PUR� <br /> I, the undersigned, state that to 1:he Ues{: of: my Iatow7.edge <br /> i�h�� aUove ll�f�;:!:t��i:].on is i;rue and complete. It is understood that <br />� tL•e lea�d agency may withdr.a�a any clecl�iration of non-s i.gnPicance <br /> t'�at iL- migh{: issue i.n reliance upon this checl:.l:ist shou].d there <br /> La a�ey misrepresenlaCion of lacl: of full. disc7.ostire�on my p��it=: <br /> (� i . � <br /> ]troponen{�: �_l_-.,--���--��-^,--!_t_r.� <br /> T\J, DECL11R11'1'TON OP P.ESI�ONSi1�L1: OPl'ICInL:�l <br /> �'he abv��e descri'aed projeci: is a �najor CicCiou �ai.i:h <br /> (signi.f:5.cant, insic;nificant) impac� and (�vil]., wi11 noi:) requir.c an <br /> L'nviro�imental Impact- Statemeni:. <br /> • I:espon;,ib.le Ui:fici�i.t <br />� • :� <br />� <br />