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ENVLRO�ttifi�7'AL CIICCF:I.IST <br />($50.00 Pce Required) `' <br />, • <br />Introduc[ion: The State F.nvironnenCal Policy Act of 1971, ChapCer 43.21C, RCIJ, requires all <br />state and local p,overmental agencics [o consider environmen W1 values bath for their ovn <br />actions and khen licensing•private proposals. 7'lie Act also requires that an EIS be prepared <br />for all major ac[ions si�nificantly affecting the qualiey of Che environment. The purposc <br />of this chec}:list is to help the agencies involved determine whether or not a proposal is such <br />a major action. <br />Please answer the following qucs[ions as compJetely as you c�n vith the infotmation presently <br />availablc to you. Idhere eiplanations of�your answers are required, or where you bclie��c an <br />er.planatian would be hel.pful to government decision makeis, include your er.planation in the <br />space 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 relevanC to the answers you provide. <br />Comple[e answers [o these questi :s now will help all agencies involved o�ith your proposal <br />to undertake the required enviro��nental review without unnecessary delay. <br />The following questions apply to your total proposal, not just to Che license for khich you <br />are currently applying or the proposal for which approval. is souglit. Your ans�;ers should <br />include the impacts which �aill be caused by your proposal i,�hen it is corpleted, even though <br />completion may not occur until so:netime in the tuture. This i.ill allow all of the agencies <br />�rhich will be involved to complete Cheir environnental revie�, noca, without duplicating <br />paper Nork in che future. � <br />�OTE: 'This is a sl•andard for�a bei.ng used by all state and local agencies in the State of <br />ti'ashington for various types of propos2ls. Piany of the questions r�ay not apply L'o your proPosal.. <br />If a questior. does not apply, just answer it "no" and conCinue on to the next question. <br />EA'VIRO.\^:IEt�TAL CHECKLIST FOfUt <br />1. BACKGROU\D <br />1. Name of Propon�nt (� (3 )3 j7 4- n %�orfn{vs/,�_p <br />2. Address and. Phone i�umber of Proponenl': z gy/ ��� J�{� �vtvs7l'j K/o. 9d2o/ <br />�c—� _ �ii i <br />3. Date Cliccklist Submi.tted <br />4. •Agencl� Bequiring Checklist__ <br />5. 1�ame of Proposal, if applicaUlc: <br />G. Naturc and Bricf Description cf thc Proposal (including but not limiCed to iCs sizc, <br />geneial design elements, and other factors thaC will gi.ve an accurate widerstandi.n,r, <br />of its scopc and naturc): �J 2� c. Sc� a�.f.l:: ,. �a n���x,T�r•� <br />7. LocaCion of Proposal (describe the phpsi.cal setCing of the proposal, as well. as [he <br />ertent ot the land arca afCeC[ed Uy an�• envirrnmicnCal impacts, including �ny olher <br />infonnation necded to give an accurate undersCanding o[ the environmeneal settittg of <br />the propusal; : � ,,�t,��_ <br />O��l�=�..., y.� s� -�t r��-7-�u.,,Q �'.�-f � h <br />8. L•'sl'imatecl Date for Comple[ion o[ [he I'roposeJ AcCion: �0 3� /jS'� <br />