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' � ... . .�u .�.. f G .. LJ <br /> " ' 1�) (S�'�.00 Fee Required) � <br /> :ntro�o�: The Sta[e Enviror.�e�ta1 Policy Ac[ oF 1971, Chap[er 43.21C, RCI1, requires all <br /> tzte and local governmental agencies to consider envirorental values bo[h for [heir own <br /> ctions and when licensing private proposals. Th� Ac[ also requires that an EIS be prepared <br /> ffrthis che¢klistiisstolhelplthetagenciesCinvolved9de[erc�ine c;he[herlornnonta The purpose <br /> major action. proposal is such <br /> lease ans-ae: [he followiny questions as completely as you can With the info n�ation presen�ly <br /> -vailable Co you. I,�ere e:cpl�nations of your answers are required, or c:here you believe an <br /> xp'_ana[ion wouid 'oe help:ul to governLent decision aakers, include your etplanztion in the <br /> pac� provided, or use additional pages iE necessir• , y <br /> ePorts or studi.es of which you are auare ar.d wnichjare relevzatdton[hedar,swetsenous to any <br /> orple:e answe:s [o these questions now wi11 help all agencies involved with <br /> o under[a.L•e the requi�ed environaental review without unr.ecessa:� delay, y provide. <br /> your proposal <br /> he follocaing ques[ions anp?y [o your to[al proposal, no[ just [o the license for which you <br /> re c'utrently zppiy1,3 or the proposal for which approvat ±s sought. Your anscaers should <br /> aclude [he iToacts ::hic4 c;ill be caused 'oy your proposal vnen i[ is completed, even [hougn <br /> oapletion ��p ;�o� eccur until sometime in [he f�ture. ?'his will allow all of the agelcie� <br /> hich vill be involved to co;�plete [heir environ�en[a1 review now, c�ithout du i <br /> apet vork in [he fu[ure. <br /> p_ica[ing <br /> OIE: This is a standa:d forn beir.g used by all state and local=agencies in Ch State of <br /> ashington for various types of pr000sals. Many of the ques�[ions n:y not apply_to your proposal. <br /> f a ouestioa does not apply, just answer it "no" and continue on to [he next question. <br /> �'VIRO\'.�*,E;;T,1L CHECi:I.iST FOR�S <br /> .. .. - �� ._- <br /> B:iCKGAOUi� �.w.s:: :.:� �-.�..:�si ''T- <br /> � � <br /> ,� <br /> /� / �:+�.LJ���; <br /> 1. Yame .oc Propo,^.ent !f f �-- <br /> 2• Address aad Phone :imbet of Proponel[: <br /> -,�.�� 3�-�'�7-Sr �„�/�.�rc-�f� ��` �i.�=,i� _ <br /> 3. Date Checklist Sub�itted��' � /9�� _. <br /> 4• Agency �equi:ing Chec'.<iist�'���_�,�./���.��nG <br /> 5• hame of 2roposal, iz applicable: <br /> 6• Dlatur= and 3:iei Desc:ip[ion of the Pro o�al i� <br /> general desi;r, ela�ents, and other factors thatnc; llg�vzuanryccurat�unde:s[anding� <br /> oE its SCO'�E a�c? natu;A) ;��,t� �.X .g��.r � � i <br /> n ,��.c-,�7 � . —_� .��!X 4/ '� I <br /> �T/J/ F/ �,-✓. ��- <br /> � ����%i .� <br /> 7. Location oE Proposal (describe the physical setting of che proposal, as well as [he <br /> ex[en[ of tha Land area afiec[ed by any environmental impacts, including any other <br /> infonatio❑ needed [o give a accurn[e unders;,�r.dino <br /> [he proposal) ;�,�+� j��/a�--�� � �,�� �y �z the enviror.�entyl setting ot <br /> A�"-G`L����_Or"nC� --�y»f'•:fY ' /,�� �/�+�E"�rr" <br /> 7---�-��,� .c� 'J AJ� ,,7 � s/,-•-•_ <br /> 8. cs[Lnated Dete iur Comp?etion oc che Proposed Actio;�; F <br /> .��� �. /y'79 <br />