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6NVIRONPIF.N'f�1L CIIL•'CKLIST <br />($25.0� Fcc RequireJ) <br />s7ntroduction: Tlie State Environmental Policy Act of 1971, Ctiapter �i3.21C, RCIJ, requires ull <br />tate and lor.al �overnmental �ge�,cics to considcr. enviranmental valacs UoNi for thcir own <br />actions and when licenninF private proposals. Tl�e Act also requires tliat an L•'IS be prepared <br />for all ma,jor nctions siFnificantly nfEecting the quality of the environment. The purpose <br />of this checklist is to ltelp the a�encies involved de[ermine whether pr not a proposal is such <br />a major action. <br />Please answer the follocaing quesCions as completely as you can with the information presently <br />available to you. Idhere explanations of your ans�aers are required, or wtiere you believe an <br />explanation would be helpful to gopernment decision makers, include your explanation in the <br />spaca provided, or use additional pages if necessary. You should include references to any <br />reports or studies of which you are awarc and which are relevant to the answers you provide. <br />Comple[e answers to these questions now will help all agencies involved with your proposal <br />to undertake the required environmental revieca without unnecessary delay. <br />The following questions apply to your total proposal, not just to the license for wtiich you <br />are ci�rrently applying or the proposal for which approval is sought. Your answers should <br />include the impacts cahich will be caused by your proposal when it is completed, even though <br />completion may not occur.until sometime in the future. This �aill allow all oE the agencies <br />vhich will be involveci to co�nplete their environmer.tal review now, wi.thout duplicating <br />paper work in the future. <br />�OTE: This is a standard form being used by all state and local agencies in tiie State oE <br />[dashington for various typas of proposals. Zfany of the questions may not apply to your proposal. <br />If a question does not apply, just answer it "no" and continue on to the nest queseion. <br />EWIRO�fEYTAL CHECKLIST FpRl�1 <br />T. BACKCROUPiD <br />1. Name. oF Proponent ,�,�jLLiS ,[,/�/.rEs pRoFiT SKNzi.�%y� T12rlST <br />2. Address and Fhone Number of Proponent:_gZ/o 54• �Bl10d[�tc1,{� ,�yEk'E77 �63-77Z7 <br />3. Date Checklist Submitted <br />4. Agency 4equiring Checklist C/7Y DF ��/E"�Pr7T <br />S. Name oE Proposal, if applicable:_ajOii�,✓ Yo a.iTi�.l�w/TaG GL!�it� .✓rr�ei,�/�c� <br />6. Nature and Brief Description of the Proposal (including but not limited to its size, <br />general design elements, and other factors th�t w:ll give an accurate understanding <br />of its scope and nature): 5�c�5.F. IVeReHodsE �.��niTio�! <br />7. Locltion oE Proposal (descril�e tlte physical settiny, oE the proposal, as well as the' <br />extent oE the land arca afEected by any environmental impacts, including any other <br />inEo rni�tion nceded to give a� accurate undcrs[anding oE the environmental sel•tinE of <br />the proposal): ,4DDir,or� iS ,qT rµE s.� CorZ✓F2 oF 5.62.�e,pw,4�� 7rH smsr�.��� <br />—� <br />_ �.�TIVE�� �VO .Y/ST/.t/!f' oY��Lp/.t/!f"S 7}f< �i�7 �Ziy T� PSOTN :1/OE� /1[�E GZQ��--` • <br />�5 /S i ffE�DI:OP�Y : N6 ADOiT�O.t/ /s o,(�• . <br />—r- <br />8. Bstimated Uate Eor Completton oE thc Proposed Actton: /,lA,QCf-! /97�i <br />