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�, � liNV11.O1dtalil:Ti(T. CI11•sCKl.l`;T <br />l <br />Intre(,hlrtion: The Statr, rnvironmental policy Act of 1971, <br />Cl IpEer �,.'1iC, )2CAV, )-CgUire:i all str.te.r.nd local governmental <br />llgBnCi.l! i to CP1151(leI Cn ircnmental vrtllICS both for theil' 01"l <br />actions and .,hen licensing- private proposals. The Act :dso <br />requires thr,t nn L•'IS be prepnred for ail major action!, significantly <br />affecting the quality of the environrncni. The purpose of this <br />cheekltst is to help ill() agcl!cics invohrcd determine whether o_' not <br />a proposal is such a major action. <br />Please ans;reT, . the folloteintg questions as completely as you Can <br />with the inror!nnt[on presently availcble to you. Allure exp)r:nations <br />of your answers ,pre required. or where you believe nu explanation <br />e:ouk} 1: c helpful to government dc.Cision malcrss, include your <br />cx}>lanciicat in the space provided, or urne adc'..itionai pages if <br />acres: rlry. You should include references to any reports or studies <br />of vrhioh you are nw.nre and t:hich are rel�crnt to the answers you <br />nrovi �C. Compietc ollstv(^rs to these q i ,ito nI. not^� will hrlp all <br />egencies invOlVed with your propor(:1 to undertake the required <br />e11vironmellta1 review without ttnuecer:sary delay. <br />'1.111e follot•ri1lg- questions apfily to your total proposal, not just to file <br />lieellnC fU?' ?': 11iC11 you or, curlent}y sprAySing or the it^^^�nl fM' <br />which approval is sough(. Your answers slnollld inelude the impacts <br />which will be caused by y our proposal vdien it is completed, even <br />though coll'plclion may not occtn mail se:netime in the future. This <br />tt^i11 allot^� pal of egencirs .tllicll will he involre� to complete <br />their environmental review now, without duplicating paper^yarn, iu <br />the Alturc. <br />NOTE: Tllis is a stan(lard form bein used by all state and local <br />agencies ill the State of i'1l ashil if toll for various types of proposals. <br />itirlly of the questionns may not npply to your propescl. If n question <br />(loon not apply, ju.:t answer it ullo,, and continue on to the next <br />quest ion . <br />ENVIT1ONMENTAL CHECKLIST FORM <br />T. BACKGROUND <br />Joe A. Morgan <br />1. Name of p:rcponent --- <br />2. Addre:;:1 and Ylloui Ntttnbev of Ill-opOnent: 3537700 <br />_ 1426 Itucker_lvenue _ <br />^ ,_Gverett� �l!aclliltb�,stl__..23.°.01_—•-------. <br />3, i)rrie ciicekl :;t f?nimritted �. Alarch 14, 7977 __ �� — <br />