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_l . i <br /> - - . _— - -- • r ' . Yea Idaybc No <br /> • . . ` -: • r ualit � <br /> Recreation. W111 [he proposal result in an impact upon the q Y _— — <br /> (19) __�- or[unities? <br /> or quantity of existing recreational opp <br /> Explana[ion: , <br /> s��heoloQical/His�orical. 47i11 the proposal resultstructure,eobject v' ' <br /> �Z�� —�ificant archeological or histoiical site, � <br /> of a sig . — <br /> or building? <br /> Explanation: <br /> ' i <br /> I <br /> . j I <br /> � <br /> III, SIGNATURE • � <br /> I, the undersigned, state that to the best of my knowledge the above information is <br /> true and complete. It Ss understood that the lead agency maY <br /> withdraw any declaratio�isrenresen- <br /> significance that it mif;ht issue in reliaaTY,�Pon this checklist should there be any P <br /> tation or lack of full disclosure on my p „ A���' /�aV� <br /> . Yroponent: ��.- ! <br /> IV. DECLARATION OF RESPO\SIBLL OFTICSAL: `. <br /> The above described projec*.. is a �ajcr action with (significant, insignificant) <br /> impact and (will, will not) require an Envixonmencal Impact Statement. i <br /> i <br /> � � <br /> ! <br /> Responsible Official ` <br /> � <br /> � <br /> I <br /> . _ .. . I <br /> ( . . <br />