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P <br />�� �� <br />. :'.: P.." 4l.� f: �-l� <br />:(gg�� P,Ecreacion. 'dill �he proposal result in an impact upon the qualitq l '' <br />or qr— CY of existing recreational opp�rtrnities? _ � <br />Explanation• <br />`20' ofcaesignific/antsarcheologicallorhhistorical sitz,tstructure eobject , <br />or building? -- �—� <br />Explanation: <br />:II, SIGNATLRE <br />I, the undersigned, state that to the best of my knowledge the above information_is <br />:rue and complete. It is understood that the lea <br />�ignificance that it mi8fit issue in reliance upon <br />atioa or lack of full disclosure on my part. <br />ip, DECLARA:ION OF RESPONSIBLE OFFICIA:: <br />The abwe described project is a major action with (significant, insigaificaat) <br />mpact a.'td (will, will not) require za Eavironmental Iapact Statement. . <br />ResponsiUlz Official <br />