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Yes Maybe No <br />(19) Recreation- WexistingprecrestionallX <br />the t in an impact opportunities? upon the quality —_ —_ <br />or quantity of <br />Explanation: <br />(20) ArcheologicallHistorical. Will the proposal result in an alteration of a significant archeological or historical site, structure, object R — -- - <br />or building? <br />Explanation <br />II. SIGNATURE <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 lead agency may withdraw any declaration of non- <br />.ignificence that it might Sssue in relianceupon this checklist should there be any misrepresen- <br />ation or lack of full disclosure on my part. <br />Proponent: / <br />IV. DECLARATION of RESPONSIBLE OFFICIAL: cant, insignificant) <br />signifi <br />above s a major <br />.,pact andshe seproject laction <br />(will, willnot)requLreanEnvironmentalImpacthStatementB <br />Responsible Official <br />rl' Li�','. <br />J <br />, <br />