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� ri.1YVC no <br /> . . ' . . . . , • • I <br /> (19) RecrT eatlorc• 11111 the proposal result in an impact upon tfie quali[y � <br /> , or quantity of existing recrea[ional opportunities? _ X I <br /> _— � <br /> Explana[ion: , <br /> (2f1) Archeological/His[orlcal. Will [he proposal tesult in an alteration <br /> of a significant archeological or historical si[e, struc[ure, object X � <br /> or building? — — <br /> ' i <br /> Explanation: <br /> CII. SIGNATURE <br /> I, the undersigned, state that to the best of my knowledge the above inforr�ation is <br /> =rue and comple[e. It is unders[ood tha[ the lead agency may withdraw any declaration of non- • <br /> :ignificance thaY it might issue in reliance upon this checklist should there be any misrepresen- � <br /> :ation or lack of full disclosure on my part. �{ <br /> . 1 <br /> � Proponent: . �-/ '` <br /> � <br /> IV. DECI.ARATIO\ OF RESPO\SIBLE OFFICIAL: � <br /> The above described project is a major action with (significant, insignificant) ' <br /> mpact and (will, will not) require an Environmental Impact S[atement. � 'i <br /> I <br /> . <br /> � Responsible Official � <br /> . � <br /> . � <br /> . , , . ,• <br /> . . . 1 <br />