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` F.NViROt7MI:Di'I'AL CIIECY.i.IST D �' S <br /> • ($25.00 Fce Required) OCT 3 �`��a <br /> ��rY• or �veiz�TT, � <br /> Tntroduction: The State Environrcental Policy Act oE 1971, Chapter 43.21 , !t(3i'��firS��"UCpt.��� � <br /> sta[e and local Fovernmental ny;encies to cnnslder environmental values Loth �or the{r o�,an <br /> ■ctions and vhen licensing private proposals. The Act also require� that an EIS be prepared <br /> for all ma.jor actions si7,ntEicantly aEfectin� the quality of the environment. The purpos� <br /> of this checklist is to help thA agencies involved determine vhether or not a proposal is siicli <br /> a major action. <br /> Please answer [he folloving questions as completely as you czn vith the information presentl} <br /> . available to you. lvhere explanations of your answers are required, or whcre you belie�•e an <br /> explanation vould be helpful to government decision makers, include your explanation ir, the <br /> epac� provided, or vse additional pages if necessary. You should include reterences to any <br /> reports or studies oE which you are aware and which are relevant to [he answers you provide. <br /> 'Complete answers to these ques[ions now will help all agencies involved with your proposal <br /> Eo undettake the reGuired environtiental reviev without unnecessary delay. <br /> The following questions apply to your total proposal, not• just to the license for whicl� you <br /> are currently applying ot [he proposal for wtiich approval is sougnt. Your answers shoul.d <br /> include the impacts c;hich will be caused by your proposal when it is completed, eden thou�h <br /> completion may not occur until sometime in [he future. This will allow all of the agencies <br /> ttuich will be involved to complete their environmental review now, withouC duplicating <br /> paper work in the future. <br /> NOTE: This is a standard form.being used by all state and local agencies in the Statc of <br /> Washington for various types of proposals. Many of tiie questinns may not apply to your proposal. <br /> If a question does not apply, �ust aaswcr it "no" and continue on to thc next qvestion. <br /> E4NIRUN:SEt7TAL '�ECf:LIST FOR"1 <br /> 1. BACY.GROUND <br /> 1. Ncu�e of Proponent �>i�� �� h�'�t�l� "QQ����'��� <br /> 2. Address and Phone Number of Proponent: Q.�IQ' S r+�'+'�e SC f ��,rc R l,�t�� ���,L,.,J <br /> 3. Date Checklist S•ibaiCted (�c-� ") t� <br /> 4. Agency Sequiring Checklist <br /> 5. Nane of Propo::al, if applicable: 1 ; �A — <br /> 6. Nature and 9rief Descrip[ion of tlie Proposal (including but not limited to its size, <br /> general design ele:nen[s, and o[her fac[ors tliat will �ive an accurate understandino <br /> of its scope and nature) : �' t ��� iT � %�t�h -i. i+ni�".1 1.•'i• '�-�+� ' " <br /> L-1. 1 IS�i i f i � -lr • � - -�r'..� c.� I . <br /> � k. <br /> k <br /> 7. Location o` Proposal (descri6e the phcsical setting oF the proposal, as uell as che ' <br /> exten[ oE tlie land arca affected by any environmental impacts, includin� any othe: <br /> infonnation neede3 [o give an accura[e und_rs[anding of [ho environmental se[L'in�, oi <br /> thc proposal) :. ��, /-�ri �t1 J'Cr'1li •� �IYP3K(n•K S � - )a C/' ,1'r,�L'G L�1�Lc �'t <br /> ���"L.• �/ � ; i L " "-r � ] [� lk �P '� � I�i ��'<'tiS t ' II 4 i�/(� �� . i <br /> —�—o— <br /> �t'(' a� ''IJ 1` ___ , <br /> � i-v r. I <br /> S. Estir,ia[ed D.�[e ior Completion of U�^_ Propoced Action:�ar'111.�✓YI� )� A__ <br />