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1 <br />E�VIRO;"iL•;::A;. C'.ii:CRi�ST <br />Less than $1,000,000 value - $50 <br />$1,000,000 value or more - $100 <br />1 <br />Introduction: The State Environmental Policy Act of 1971, Chapter 43.21C, RQ1, requires : <br />state and local governnental agencies to consider environmental values botlt for their own <br />actions and when licensing private pr000sals. The Act also requires that an EIS be prepar�_ , <br />For all ma.jor accions significantly affecting the quality of the environmen[. The purpose <br />of this checklist is to help the agencies involved decermine wheeher or not a proposal is s�__:. <br />a major action. <br />Please answer the following questions as completely as you can with the information present_ <br />available to you. flhere explanations of you: answers are required, or where you believe an <br />explanation would be helpful to government decision makers, include your explanation in [he <br />spac=_ provided, or use additional pages if necessary. You should include references to any <br />reports or studies of which �ou a_e a::a:c �r.d ::?:ich a_e relevant to the answers you p:��:??c <br />Complete answers to [hese qvestions now uill help a1lYagencies 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 ye� <br />are currently applying or the proposal for which approval is sought. Your answers should <br />include the impacts which coill be caused by your proposal when i[ is completed, even ehough <br />completion may not occur until sometime in the iuture. This coill allow all of the agencizs <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 Staee of <br />ldashington for various types of proposals. Many of the questions r�ay not apply to your pr <br />If a question does not apply, just answer it "no" and continue on to the nest q�ies[ion. <br />ENVIRONMENTAL CHiCKLIST FORlf <br />1. BACKGROUND <br />1. Name of Proponznt i i / O f � l'� �' 4%/ <br />2. Address and Phone Number of Proponent: ,300� !2'�=Tnfn.1� T1=d�,�'cTi <br />,.r ��jt9 sr7YS �i�r /ci7iN! OLONr-Iuc.c�-� _ <br />3. Da[e Checklist Submi[ted ijN %.'�� /%�+ 3 — <br />4. Agency Requiring Checklist C i r i O.� ,C= v�= .e �� r <br />5. Name of Proposal, if applicable: [�,�/� O 4 i T iU N �',.G 38'l7 Yl/. rN A�' � N� <br />Vir-u/ 170ivi� -_ <br />6. Nature and Brief Description of the Proposal (including but not limi[ed to its size <br />general design elemen[s, and other factors that will give an accucate pnderstanding. <br />of its scope and ature):� �� -� � /�e ,�u} 3 n1"w-�..i _�,�.rr-� .�:��. ._ <br />V�..�.. �_...v , . � � .�_�...._... ./ i/ /.-.�i - -. //�.� . ._...-.-.- .... _ if: / w, .l� - <br />7. Location of Proposal (describe the physical setting of the proposal, as well as [r. <br />extent of the land area affected by any environmental impacts, including any o[her <br />infoxmation needed to give an accurate unders[anding of the environme tal setting ;` <br />the proposal) : 7,(, �,.,__��.i�„t� �..e :�i�.i,y 9A_�..-r� 1�Ir-u.� ,.� :' ' Ea� i� •�A <br />�, 8. Estimated Da[e for Completion of the Proposed Action: <br />