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ENVIRONMENTAL IMPACT ASSESSMENT <br />(STAFF RECOMMENDATION FOR INTERNAL USE ONLY) <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 an Initial Study of this project in accordance with the <br />Lead Agency's "Local Guidelines for Implementing the California Environmental Quality Act (CEQA)" for the <br />purpose of ascertaining whether the proposed project may have a significant effect on the environment, has reached <br />the following conclusion: <br />a. ❑ <br />The project could not have a significant effect on the environment; therefore, a Negative <br />Declaration should be adopted. <br />b. ❑ <br />The Initial Study identified potentially significant effects on the environment but revisions in the <br />project plans or proposals made by or agreed to by the applicant would avoid the effects, or <br />mitigate the effects to a point where clearly no significant effects would occur; therefore a <br />Mitigated Negative Declaration should be adopted. <br />C. ❑ <br />The project may have a significant effect on the environment; therefore, an Environmental Impact <br />Report will be required. <br />Date: <br />Staff: <br />Environmental Impact Assessment FORM "C" <br />75D-185 <br />