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ENVIRONMENTAL CIIECKLIS# <br />($25.00 Fee Required) <br />Introduction: The State Environmental Policy Act of 1971, <br />Chapter 43.21C, RCN, requires all state and local governmental <br />agencies to consider environmental values both for their own <br />actions and when licensing private proposals. The Act also <br />requires that an EIS be prepared for all major actions significantly <br />affecting the quality of the environment. The purpose of this <br />checklist is to help the agencies involved determine whether or not <br />a proposal is such a major action. <br />Please answer the following questions as completely as you can <br />with the information presently available to you. Where explanations <br />of your answers are required, or where you believe an explanation <br />would be helpful to government decision makers, include your <br />explanation in the space provided, or use additional phges if <br />necessary. You should include references to any reports or studies <br />of which you are aware and which are relevant to the answers you <br />provide. Compete answers to these questions now will help all <br />agencies involved with your proposal to undertake the required <br />environmental review without unnecessary delay. <br />The following questions apply to your total proposal, not just to the <br />license for which you are currently applying or the proposal for <br />which approval is sought. Your answers should include the impacts <br />which will be caused by your proposal when it is completed, even <br />though completion may not occur until sometime in the future. This <br />will allow all of the agencies which will be involved to complete <br />their environmental review now, without duplicating paperwork in <br />the future. <br />NOTE: This is a standard form being used by all state and local <br />agencies in the State of Washington for various types of proposals. <br />Many of the questions may not apply to your proposal. If a question <br />does not apply, just answer it "no" and continue on to the next <br />question. <br />ENVIRONMENTAL CHECKLIST FORM <br />I. BACKGROUND <br />I. Name of Proponent Donozh :{ones Inc. <br />2. Address and Phone Number of Proponent: <br />�24h0 �9th Ave. '4. �. <br />._.A <br />42,_nI ,1 <br />3. Date Checklist Submitted ::arch 10, 19YJ <br />