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� � �� <br /> _ , ($50.00 Fee Required) , <br /> Inttoduction� The State Envlronmentnl Policy Act of 1971, Chapter 43.21C, RCW, requires all <br /> etate and local governmental agencies to r,onsider environmental values bo[h for their ovn <br /> actlons and when licensl�ag priva[e proposals. The Act also reqaires Chat an EIS be prepared . <br /> for all major actiona aignificantly affecting [he quality of the environment. The pucpose <br /> of thia checklist is to help ehe agencies involved determine vhether or not a proposal 1s such <br /> a ma�or gceion. <br /> Please ansver [he following questions as completely as you can aith the information presently 1 <br /> avatlable to you. frhere explanations of your answers are required, or where you believe an <br /> euplanation would be helpful [o government decision makers, include your explanation in .the <br /> spacs provided, or use addittonal pages iE neceseary. You ahould include references to any <br /> reporta or atudies of which you are aware and vhich are relevant to tha anavers you provide. <br /> Complate answera to [hese questions nav will help�all agencies involved vith your propoeal <br /> to uadertake the required environmental review vithout unnecessary delay. <br /> ihe folloving questions apply to your total proposal, not just to the license for vhich you <br /> are eurrenely applying or the proposal for vhich approval ls aought. Your ansWers should <br /> Lnclude [ha impacts vhich aill be caused by yuur proposal ahen it is completed, even though � <br /> :ompletion may not occur until sometime in the future. This vill allow all of ehe agencies <br /> �hich vill be involved to cooplete their environmental review aow, without duplicating <br /> �aper work in [he future. , <br /> vOTE: This is a atandard form being used by all state and local agencies in the $tate oE , <br /> �Jaehington for various types of proposals. Many of the questions r�ay not apply to your proposa <br /> If a question does aot apply, just answer it "no" and cantinue on to. the next question. <br /> 3NOIRONHENTAL CtiEC[a.IST FORM , <br /> L BACKGROUND . <br /> 1. Name of Proponent �,E'/- 5 %/� %L= 'G'/.i:�T l��L i I U r�l lN L - <br /> 2. Addreea and Phone Number of Proponent:�Sn 1^� �+ /a.�C= ���_ - <br /> IJi_. L�LVIJ - V�/A 9 £'� �-c�d.. 45� J- `� 7C= --- <br /> 3. Data Checklist Submitted j/- 3 D -,f' 3 - <br /> 4. Agency Requiring Checklist �= 'e7Lc7T f�i4.t.'•U.^�� . <br /> 5. Neme of Proposal, if applicable: <br /> 6. Nature and BrieF Description of the Proposal (including 6ut not limited to ita size, <br /> general deaign elements, and other factors that vill give an accurate underatanding <br /> of its scope and nature): r PetiD ��LL P�Pi(�r P.��Lv '� c���� t� "� r.o ' s..�' c. r <br /> T-:!C(_'�. � 5 AP.��:c„i ir�d;'tt.+��. 7.��'u� tt'7J1� y..l"'J' TG /��-7IJAil• n�' :� �' — <br /> /�F7tS^ C.i:LST� C'i�:.+IA:G �'�0 1/!']����l.:�l� /1�,.:7..ii i�ci_�. LC_i ('t'�r1Jfi_"ZZ:.I) <br /> 7. I.ocation of Proposal (describe the phyeical se[ting of the proposal, ae well as the <br /> r�ctent of tlie land atea affected by any environmental impacts, including any other <br /> information needed to give an accurate understanding of the environmental aetting� of <br /> the ptoposal):��;C v.�) r l r 7 J 5 L� i3v lT2 i S Y7iTb /=��' G/�G ��? <br /> S�Gc:.Ni � �'n USC ���' [�P(�� [�F i!>o1P'�i/JL <br /> 8. Eatlmated Date for Completion of the Proposed Action: ,�d� I �8 4- <br /> 3 <br /> � <br /> 1 <br />