7514 EVERGREEN WAY 2016-01-01 MF Import

Yes [4aybe No (e; Storm wa��i _.ainaqe? • - (f) Solid waste and disposal? ^ Explanation:� ^-�;;. �'i�':E% f.�;=� ^:y .::"'; ,��-�) , �1 �/ , , i/F=�� FI'�;�n�`ti'.��> ;!�i.-- I"� J 1":d' �� i�f'� i (17) Human Health. i9i11 the proposal • result in the creation of.any health hazard or potential health hazard jexcluding mental health)? _ • y Explanation: (18) Aesthetics. S•iill the pronosal re- sult in the obstruction of any scenic vista or view open to the public, or wi11 the proposal re- sult in the creation of an aesthe- tically ofiensive site open to public view? f7cplanation: (19) Recreation. Will the pr000sal re- sult in an impact upon the quality' or guantity of existing recrea- tional opportunities? Explanation: (20) Archeoloqical/Histori.cal. Will the ,groposal result in an alteration of a significant archeological or his- torical site, structure, object or building? Explanation: X � I-r- �IT �, III. SIG�IATURE � ', I, the ur.dersigned, state that to the best of my knowledge the above information is true and complete. It is r.derstood that the lead aqency may withdraw any declaration of n�°signfica ce that it might issue in reliance upon this checkl' should re be any misrepresentation of lack of full disclo,su e m � t. Proponent: ' / � IV. DECLARATION OF RESPONSIBLE OFFICIAL: �� The above descri6ed project is a r�ajor action with (significant, insignificant) impact and (will, will notj require an Envirormiental Impact Statement. ' . , 0 Responsible Official . u �.