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<br /> ' � U� !T �D/�n-r►�'� �:ravrr,oret!(t;i'AI, f.111:CF;l.(5'f , %Q�1 �� � ��,.-
<br /> CNc.n'n�'r' r'�'�,�'-,t cszs.00 r•«� s�n�i«a> , u/,�-. �. � �,.� -r>va-,
<br /> (' 1��'i�-��1G. r �r.�j
<br /> s[n[eintroduc�ion; The State finvironmental Policy Act of 1971, r��,��ter 4).21C, kCW
<br /> and local ;o•�ernmon[al nj;encles to constder envlronmental values Loth for thelr own
<br /> ac[lons and when lfcensLn � + r�qufrrti a; �
<br /> for alI .r.a1or ac[tons st;;nificantly�affecting [ho`q^�]1tYSofr��,r�environment. EI'[fi�e�urpr�,;�.
<br /> of this checklist is to hclp the agencles involvr_d �etermine vhe[her or not a �r( r7rc,
<br /> a major action.
<br /> proposal Iti s,��;�
<br /> Please answer the follow[ng ques[fons as cumple[ely as you c�n with the informacion
<br /> avnilable [o you. !.'�ere explanaticns of your unswers are required, or aliere
<br /> explanation uould be helpful to precen[lq
<br /> .pace provided, or use additional�pageseif nece�sar makers, include Yau belteve an
<br /> reports or studies of which you are aa�are and which are relevan[ to [he answersaCoun in the
<br /> ' Comple[e ar.swers to these questions now will help all agenciesuinvolved�withferences ta :,ny
<br /> Co undertake [he required environnen[al review without unnecessa Y Provide.
<br /> your prc,posal
<br /> 1'he £ollowin t'Y delay,
<br /> P, questions apNly Lo your [ot;!1 proposal, not fust [o the license for vhich.you
<br /> arc currently applying or the proposal for which approval is sought. Your answers ehould
<br /> include the impacts wh?ch will de czused by your proposal when it ic conple[ed, even thougii
<br /> vhichewill beyinvo.ivedutoucompletee[heirienvironmental review now, wi[h�ut duplicatin
<br /> This will allo4 all of the a encies
<br /> paper vork in the future.
<br /> B
<br /> NOTE: This is a s[andard fotm being used by all sta[e and lacnl ;.�enciea in the Stat= of
<br /> Ifgainuestionrdoesino[ aYpls of proposals. Many'of the questions may not apply to your pro,posal. �
<br /> q PP y, �ust ansFer it no and continue on to the pee��cc ,.py� �{
<br /> ENVIRON![ENTAL CNECKLIST FOFM � I _p �tIK INsI " q�j`7 (t �
<br /> 1• BACKGF.OUND �F-� i��� LS lJ u lI 15
<br /> 1, Name of Proponer ` ur/y,r�y�jJp� �() �G. ��T � �9�4
<br /> 2. Address and Phone Nwr.ber of Proponent: l�Q. � i,s7� � � � �
<br /> r �y��wa�v w�i�z:�, .,, .,_,,�.
<br /> ��1 . .:� �:-------
<br /> 3. Date Checklist Submitted QG1 Z /97(� ' .
<br /> 4• Agency Requiring Ct�ecklis[ �JP�� '- "
<br /> !�I/4�i4�r L�J.9L�f.rlG"af
<br /> 5. Name of Proposal, if applicable:
<br /> ePT /�caLf�!- g 40�� '�a°f".�e�f h4�v_sE pq C�r
<br /> ��n
<br /> 6. Nature and Urief Descrip[io� of the Proposal (including but no[ llmited to its size,
<br /> general design elements, and o[her fac[ore that will give.an accura[e u derst�r.ding
<br /> of iXs scopc and naturQ): S C(/f�j ,¢2tM
<br /> 5 �Z� i� 5.z� r� cv, f�r te�� ,��>e •
<br /> 7. LocatSon of Proposal (descrlbe the physical settin� of [he proposal, as vell na the ,
<br /> extent c[ the land r.rea affe�ted by any environnen[nl imp;�cte, including any o[hc; '
<br /> information necced tn giva an nccura[e unders[an ing of [hc c vi onmentnl s ttiu • of
<br /> the proposal) ; (•;rj � 72r�3 '
<br /> 8t o�,�37.G �c�v6S !i� !jG}�iTir� �� ��✓tr/
<br /> FA: �' l PJ�c, -------
<br /> 8. EstlmateJ Date for Campletion of the Prnpoai�d Action: •
<br /> �-C� � !9� ;
<br />
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