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. 1 • � . • I <br /> •---- ENVIRON111BN7'AL ClIGCICLIST • ' � <br /> (,^p25. 0� ]�ce Pequired) � nl � � � � `�� �'' I�II� <br /> LJ I 1 J' <br /> SEP 12 lyl� � <br /> Introduction: Thc 3tntc I:nviranmental Policy Act of 1971, ' <br /> Choptci• 43.21C , RC�V, i•equires nll stutc and locnl goeernmr.ntal CI1�Y OI= E�'[:IZL'T�i <br /> , ngcncics to consicier envircnmentnl values both tor their ovrn � '�''�'' � "-�" <br /> netions and when liccnsing privnte proposnls. The Act olso <br /> requires ti�nt an L•'IS bc prepnred for nll mnjor actions .^,ignificanliy <br /> utfecting thc quality of thc environmr.�t. I'he rurpose of this <br /> checklisl is to help the ngencics invoh�ed det^.rm:nc ivhethcr or not <br /> a proposal is such a mnjor uctian. <br /> Please ans�vcr the following qucstions as completcly as you cnn <br /> • with the informr,ticn presently nvnilnUle ta you. {Yherc espinnntions <br /> ot your answers ure required, or where ,you b��lieve [+n expinnntion <br /> • ,. would bc helpCul to government decision makers, include your <br /> explanntion in the spnca provid�d, or use additiu,nl pages it <br /> necessnrv. You should include refnrences tn nny reports or studies <br /> o.`. which you nre nwnre nnd which sre rcicvunt to the nnswers you <br /> provide. Comp.ete ansicers to lhese quest�o�s now �cill help all <br /> ngencies involved with your proposul to uudertel;e tha require3 <br /> e�rvironmental review without unnecessniy delny. <br /> The follo�ving questions apply to your totnl propcsnl, not just to the <br /> license for which ;�ou are currently applying or :he propcsnl fo. <br /> wl�lch approval is sought. Your answers should include the impnets � <br /> which tivill be caused Uy your proposn] �vhen it i�. completed, even <br /> th�ugh completion may not occur until sometime in the tuture. This <br /> • will nllo�v all of the agencies �vhich will be invol�•ed to complete <br /> their environmental rPvietiv now, without duplicnting paperwork in <br /> U�e future. <br /> NOTE: This is n standnrd torm being used by all st¢te nnd local • i <br /> egencies in the State of 6tiashington for various types of p�oposals. . <br /> 117any of the questtors may not npply to your proposal. If r� qaeslion <br /> does not apply, just answer it "no" nnd continue on to the next � <br /> question. ; <br /> ENVIRONNIENTAL CHECKLIST FORM17 i <br /> , <br /> I. BACRGROUND I <br /> I. Nnme ot Proponent pr' �r.2,t- � I <br /> 2. Address nnd Phone Number of Proponent: i <br /> P. o. Bo .s c s � <br /> /7� � l u Gtl �'i 3 — , <br /> �ef �„qa.-o 355- y/96 : <br /> 3. Dnte Checklist Su itted __� // 78 , <br /> , <br />