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a <br />W �vuU V �IJ <br />' ENVIRONMGNTAT. CIILCKLIST <br />' � / MAR 619iy <br />($25.00 Fee Required) <br />Incroduction: � CI��7 �OiF EV�.��i'�°�: <br />state and local governmentaliagencieslto�considcr environment�al`valuesZboth ���their ocm <br />��rca all <br />a�tlons and wf�en licensing priva[e proposals. The Act also requlres that an EIS be prepared <br />for all ma,joc ac[ions significantly affecting the quality of the environment. The purpose <br />of Ghis checklist is to help the agencies involved determine whether or nat a proposal is such <br />a major action. <br />Please answer the following ques[ions as comple[ely as you can uith [he informaticn presently <br />avatlable to you. idhere explanations of your answers are tequired, ot where you believe an <br />eaplanation would be helpfu7. to government decision makers, include your explana[ion in [he <br />spac� provided, or use additional pages if necessary. You should include references to any <br />reports or s[udies of which you ate aware and which are relevan[ to the answers you pcovide. <br />Complete answers [o these questions nov will f,elp all agencies involved with your proposal <br />to undertake the required environmental review withou[ unnecessary delay. <br />The following questions apply to your total proposal, no[ just to the license for which you <br />are curren[ly applying or the proposal for which approval is sought. Your answers should <br />include the impacts which will be caused by your proposal when it is completed, even though <br />comple[Iun may not occur until sometime in the future. This will allow all of the agencies <br />vhich will be involved to comple[e their en-�ironmental review now, without duplicating' <br />paper work in the future. <br />NOTE: This is a standard farm being used by all state and local agencies in the State of <br />YEsainuestionrdoesinot aYpls �f Proposals. Many of the questions may nat apply to your proposal. <br />Q pp y, just answer it no and continue on to the next question. ' <br />ENVIRONMENfAI, CIiECKLIST FORH <br />1. RACKGROUND <br />1. Name of Proponent <br />2. Acidress and Phone Number of Proponent: 9,5 0� /qT/,c av�, so <br />337 — 7loOg <br />3. Date Checklist Submitted <br />4• Agency Requiring Checklist <br />5. Name of Proposal„ if applicable: /Q u,UiT � <br />Co�vmi,ri,vi iiw <br />6. Nature and Brief Cescription of [he Proposal (including but not limited to its size, <br />- general design elemen[s, and cther factors tiiat will give an accurate understanding <br />of its scope and nature): /p,�n�F sr <br />���✓S u�vOrYEl��gD �A4Ci4L w/ti,. - 7,p�s <br />� 6QOGJT/� V/L�v�,L�g T{�E Clcrdncoi.i � �.,�-..,. <br />%. Location of Proposal (describe the physical setting of the proposal, as well as the <br />extent of the land area aEFected by any environmen[al impacts, including any o[her <br />information necded to give an accura[e understanding oE [he environmental setting of <br />che proposal): ;o� ¢7i,,ti��0 g��8 `� <br />U4 k LI +�� Cev��,.r�/5 /S� 6/J�i7inw / <br />M�2ok.3v/9 IVFn.lOP �4✓G o.V t'.IJT 5�06 nc �v�T/AD.P� lvE Bnv✓ 39T�'� Io�'N5n' <br />8. Gs[im�ted Datc Eor Completirn� oE [he Proposed Action: �Ui�,�e� /9� <br />