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PRELIMINARY EXEMPTION ASSESSMENT <br />(Certificate of Determination <br />When Attached to Notice of Exemption) <br />1. Name or description of project: <br />2. Project Location — Identifystreet <br />address and cross streets or attach a <br />map showing project site (preferably a <br />USGS 15' or 7 1/2' topographical map <br />identified by quadrangle name): <br />3. Entity or person undertaking project: <br />A. <br />B. Other (Private) <br />(1) Name <br />(2) Address <br />4. Staff Determination: <br />The Lead Agency's Staff, having undertaken and completed a preliminary review of this project in accordance with <br />the Lead Agency's "Local Guidelines for Implementing the California Environmental Quality Act (CEQA)" has <br />concluded that this project does not require further environmental assessment because: <br />a. ❑ <br />The proposed action does not constitute a project under CEQA. <br />b. ❑ <br />The project is a Ministerial Project. <br />C. ❑ <br />The project is an Emergency Project. <br />d. ❑ <br />The project constitutes a feasibility or planning study. <br />e. ❑ <br />The project is categorically exempt. <br />Applicable Exemption Class: <br />f. ❑ <br />The project is statutorily exempt. <br />Applicable Exemption: <br />g. ❑ <br />The project is otherwise exempt on <br />the following basis: <br />h. ❑ <br />The project involves another public agency which constitutes the Lead Agency. <br />Name of Lead Agency: <br />Date: <br />Staff: <br />Preliminary Exemption Assessment FORM "A" <br />75D-182 <br />