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Less than $1,000,000 value - $5f <br />$1,000.000 value or more - $106 <br />Introduction: The State Environmental Policy Act of 1971, Chapter 43.21C, R04, requires all <br />state and local governmental agencies to consider environmental value:, both for their own <br />ac`ons and when licensing private proposals. the Act also requires t'.tat an EIS be prepared <br />fo. 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. kfiere explanations a' your answers are required, or where you believe an <br />explanation would be helpful to government decision makers, include your explanation in the <br />spac=_ 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 tha future. This will allow all of the agencies <br />which will be involved to complete r;ieir 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 your proposal <br />If a question does not apply, just answer it "no" and continue on to the next question. <br />ENS' ) MENTAL CHECKLIST FORM <br />1. 'SACXGROUND <br />1. Name of Proponent L�2c�c� <br />2. Address and Phcne Number of Proponent: % J I htL iv E YVI A2uS : �.t LV kJ <br />3. Date Checklist Submitted 3 5-SS"l- <br />4. Agency Requiring Checklist Et EeC{E t LJlu ti ti y i� 7�. <br />5. Name of Proposal, if applicable: /,)0 <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 'n accurate understanding <br />of its scope and natur2):�/ Ton F eo2 4 GF 3S',� <br />r1 SAW CLP t-o- a CA L��oeP `!-C=,P_A A;ptiC'N! U !` ,'AJ 'r..2,-RA£f.. <br />/ 0 Y5ECcME KNo ot) As QL-EA►:D C)C 11 1" 11u9 w,LL Gt <br />ML BU*t,n'rr /1 fIC -1nRTf1T 3,ca�c SS ri- of .ri�Nt-.:PM.!'. :pr,,X;Q Q, cr i'H+l f1I:tA w/V '1ca fAQ <br />7. Location of Proposal (describe the physical setting of the prop sal, a: well as the <br />extent of the land area affected by any environmental impacts, including any other <br />information needed to give an accurate understanding of the environmental setting of <br />the proposal): ,LCaJEn 45 S+kVICk) /161,0C 5-.�+I, 4c�c; �nl, EkE <br />toe-;+ Qcrc `:s CtL- 6�G,J hl, N ScC' Ctf2�ir`cs /)V 4- <br />8. Estimated Date for Completion of the Proposed Action: �-/'�-5 -z CtG <br />Lpp <br />dO.Lzil __ <br />