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— e: ro <br />1 <br />J <br />llnp <br />rt. <br />6i <br />5' <br />I <br />]�1N <br />u <br />IS•M ' fl <br />� <br />� <br />ac,r� er <br />: <br />i <br />i <br />��rH ar <br />JetN <br />P <br />� f�:� Pc_ ��D <br />., ,E <br />19n1 <br />� <br />LJ <br />•Oly <br />fi <br />ar <br />fl <br />1'.171'lllO;:'.II:!!'I'AL CIII;CI(I,itil' <br />($:;S.OU I�ec Req��irr,d) <br />InirnJuclion: 7'hc Sln�c GnaironmenU�l I'olicy Act n( 1971 , <br />Chupicr 49.YIC. RCIY. t'rquires nIi ctnle uncl lac:�l F;overnineidnl <br />ngencics to consider environmenlnl vnlues bolh (m' Iheir own <br />nclionc nnd �vhen licen;ing privnt� preposnls. :he Act nlsu <br />requires thnl im Ii1S Ue prrpm•cd for nll mnjor ni::o�;; si(;ni(iconlly <br />affec�ing tlte quulity oC l6c environmenL 'Che purpose ot Ihis <br />checiclist is to hcn Ihe agencics involved determine whether rn• not <br />n proposnl is such � mnjor nction. <br />Plc�isc onstvr,r Ihc follo}vin�; qocslions ns coinplciriy ns you can <br />wifh lhe informnlian presenlly nvi�ilable to you. {Yhcre e�pinn:ilions <br />of your answers nre rcquired, or where you bclievc nn expinnution <br />would Ue hclpful to govcrnment decisiom m�lcers, indude your <br />explanntion in the spnce providrd, or use nddilionN pnges if <br />necessnry. You SIIOIII(i IIICIUOL' 1'C�CPC11CC5 to nny reports or sn�dir <br />of which you nre nv:nre mid which nre rclevaN lo the nns�eers y��u <br />providc. Complcle m�swcrs to Ilicsc qucslions notv :vill hclp nll <br />n�;encies involved witi� yam• propornl to undcrinl<c the rcquired <br />em�ironmeNnl revicw wilhout unnecr.ssnry dclny. <br />7'hc follayving qucslinns npply �o yotrc lo�nl proposN. not just lo thc <br />license fur �vhich you nre curcenUy appiying or Ihc praposal !or <br />which npprovnl is saught. Your miswcrs should indude lhc impncb. <br />�vhich wiil he amsed by Yaur prnpos�l when it is compleled. ccrn <br />ihough completiom m�y not occur until sometime iu the (utiu•c. '!'I.is <br />will iJlo�•i nll of the ngencies which will be invulved lo completc <br />Iheir environmento] revicw now, �•„mo��i ��pti������,e �>nr���«•����: i�� <br />thc rucurc. <br />hOTii: 1'his is n slnndnrd [m•m t�cing used Uy ull slnlc nnd loc:0 <br />ngencics in llic Stnte o( lYnshinglon for vnrious types o[ proposnls. <br />p1nny oC thc qucslions muy �ot npply to your proposnl. IC n qucslion <br />does nol npply, just nnswcr it "nn^ ond conlinuc on lo Ihc nesl <br />question. <br />ENVIRON\IHN'fAf. CHGCRI,IS7' FORA1 <br />I. DACI(CROONU <br /><. <br />1. NnmcofProponent C��•,� -.>»�-��-;:�'. __ <br />2. Address nnd Phonc Numbec o! Proponent: <br />//�Ci• �fz�*v 7`�6" ,Ccr•i,rr ��'/� �,S'7UC <br />z��-s�a <br />3. Dnte Ched:li.t tiubmilled �?�7 _ 7-/ <br />