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. . Ycx M:i�c i'o � <br /> (19) Recrca[irm. Will tLe propo::al resul.t ln an 1mp�ct upon the quality • ` <br /> or quau[ity of er.istln� recreational opportunities? _ t - , <br /> Explana[ion: ' <br /> (20) Archeoloflical/Historical. Will the proposal resul[ in an alteration <br /> of a significant archeolo�ical or his[orical site, s[ructure, objec[ <br /> or buildin�? __ ✓ <br /> Explanation: <br /> IIZ. SIGNATURE <br /> I, the undersigned, state that to the best or my knowledge the above infornation is <br /> true and complete. It is understood that the lead agency may withdraw any declaration oE non- <br /> s3gnificasce [hat it might issue ia reliance upon this checklist should there be any ¢ _srepresen- <br /> tation or �.ack ot full disclosure on ny part. <br /> Proponen.:'—__�/��..�Q �./' ` �-r- �,;�' <br /> IV. DECLARAT.ION OF RESPONSIBLE OFFICIAL: <br /> The above described project is a mzjor action with (significant, insignificant) <br /> impact and (will, will not) require an Environmental Impact Statement. <br /> �' <br /> . � <br /> � <br /> Responsiblc Official � <br /> H H <br /> y �. <br /> H �- <br /> fA ' <br /> � O � <br /> CC+] � <br /> O : <br /> 0 <br /> � : <br /> t� � <br /> �p F. <br /> C : <br /> . y F. <br /> t� <br /> � � <br /> . - � �, <br /> 0 <br /> � ` <br /> . � . . <br /> � ' <br /> � <br /> F^ <br /> 2 <br /> ) <br /> . a � j <br />