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� ' <br />ENVIRONMGNTAL CHTsCKLIST . <br />($25.00 Fee Required) <br />Introduction: The State Environmentai Policy ��et of 1371, <br />Chapter 43.21C , RCW , requires all stute and locnl governmental <br />agencies to consider environmentnl vnlves both for their own <br />actions und when licensing privute proposals. The Act nlso <br />requires that nn EIS be prepared for all mnjor actions significantly <br />aftecting the quality of the environment. The purpose of this <br />checklist is to help the agencies involved determine whether or not <br />a proposal is such a major acrion. <br />Please answer the follotiving questicns as completely as you can <br />tvith the informution presenfly avuilable to you . Where explanafions <br />of your answers are required, or where you believe nn explanation <br />would be helpful to government decision makers, include your <br />explanation in the space provided, or use additional pages if <br />necessary. You should include references to any reports or studies <br />of which you are aware nnd �vhich are relevant to the answers you <br />provide. Complete answers to these niiestions uow will help all <br />agencies involved with your proposal to undertake the required <br />environmental review without unnecessary delay. <br />The following questions apply to your total proposal, not just to the <br />license for which you are currently applying or the proposal for <br />which approval is sought. Your answers should include the impacts <br />which will be caused by your proposal when it is completed, even <br />though completion may not occur until sometime in the future. This <br />wiII allo�v nll of the agencies which will be involved to complete <br />their environmental review. now , without duplicating paperwork in <br />the future. ' ' <br />NOTE: This is a standard form being used by all stnte nrid local <br />agencies in the Stute of Wasliington for various types of proposals. <br />Many of the questions may not apply to your proposal. If a question <br />does not appIy, just answer it "no" and continue on to the next <br />question. <br />ENVIRONMENTAL CHECKLIST FORM <br />I. BACKGROUND <br />.. <br />1. Nume of Proponent ,' �'f oNrCS ,Adr�i�� .NAi.ty ��/%_ <br />2. Address and Phone Number of Proponent: <br />.S. Date Cl�ecklist <br />