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r.nvIAU,,;7L..,AL GaLLi.LiST <br />r <br />Less than $1,000,000 value - $50 <br />$1,000,000 value or more - $100 <br />Introduction: The State Environmental Policy Act of 1971, Chapter 43.21C, RCW, requires all <br />state and local governmental agencies to consider environmental values both for their own <br />actions and when licensing private proposals. The Act also requires that an EIS be prepared <br />for all major actions significantly affecting the quality of the environment. The purpose <br />of this checklist is to help the agencies involved determine whether or not a proposal is such <br />a major action. <br />Please answer the following questions as completely as you can with the information presently <br />available to you. Where explanations of your answers are required, or where you believe an <br />explanation would be helpful to government decision makers, include your explanation in the <br />spats provided, or use additional pages if necessary. You should include references to any <br />reports or studies of which you are aware and which are relevant to the answers you provide. <br />Complete answers to these questions now will help all agencies involved with your proposal <br />to undertake the required environmental review without unnecessary delay. <br />The following questions apply to your total proposal, not just to the license for which you <br />are currently applying or the proposal for which approval is sought. Your answers should <br />include the impacts which will be caused by your proposal when it is completed, even though <br />completion may not occur until sometime in the future. This will allow all of the agencies <br />which will be involved to complete their environmental review now, without duplicating <br />paper work in the future. <br />NOTE: This is a standard form being used by all state and local agencies in the State of <br />Washington for various types of proposals. Many of the questions may not apply to"our proposal. <br />If a question does not apply, just answer it "no" and continue on to the next question. <br />AL CHECKLIST FORM <br />1. BACKGROUND <br />l.. Name of Proponent L�Qu cE. KC <br />2. Address and. Phone Number of Proponent: /(�/'��I �/1 hR NE. MA-&41Su'LKL Lyy <br />3. Date Checklist Submitted 4. Agency Requiring Checklist Eveerii P1-n[J - <br />5. Name of Proposal, if applicable: do <br />6. Nature and Brief Description of the Proposal (including but not limited to its size, <br />general design elements, and other factors that will give an accurate understanding <br />of its scope and nature): NELU n('c`uoauc,, . T-nn nJ- PL1.. <br />{T'- g Y h(�1eu5/ta.E VS 4nYM /1QfH w.yRi[1i 3� Wo LS. rT• of 'T�� SPAct - Y dvunU �:iE a F , fita,2 wi1I M+SM <br />7. Location of Proposal (describe the physical setting of tgie prop sal, as well as the <br />extent of the land area affected by any environmental impacts, including any other <br />information needed togivean accurate understanding of the environmental setting of <br />the proposal) : Zoc a ,' hnn ,4S S+A;tb A bonna c # , S C, 4� ow+N 4 eyts �M >! kE <br />N�QN,r WE5+ 4(1Cn s }-nrn 564441SCC1,1(CF12u)C45 Qg <br />8. Estimated Date for Completion of the Proposed Action: 3 -/oi — Y c hF-Q i- <br />��A2CJ f:a� <br />