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TO: <br />❑ Clerk of the Board of Supervisors <br />FROM: <br />Public Agency/Lead Agency: <br />or <br />Address: <br />❑ County Clerk <br />Contact: <br />County ofi <br />Phone: <br />Address: <br />TO: ❑ Office of Planning and Research Lead Agency (if different from above) <br />P. O. Box 3044 <br />Sacramento, CA 95812-3044 Address: <br />(overnight or hand delivery) <br />❑ 1400 Tenth Street, Rm. 113 Contact: <br />Sacramento, CA 95814 Phone: <br />SUBJECT: Filing of Notice of Determination in compliance with Section 21108 or 21152 of the Public Resources <br />Code. <br />State Clearinghouse Number <br />(If submitted to SCH): <br />Project Title: <br />Project Applicant: <br />Specific Project Location — Identify street address and cross street or attach a map showing project site (preferably a <br />USGS 15' or 7 %:' topographical map identified by quadrangle name): <br />General Project Location (City and/or County): <br />Project Description: <br />Identify the person or entity undertaking the project, including any private applicant, any other person undertaking an <br />activity that receives financial assistance from the Public Agency as part of the project, and any person receiving a lease, <br />permit, license, certificate, or other entitlement of use from the Public Agency as part of the project. <br />This is to advise that the (❑ Lead Agency or ❑ Responsible Agency) has approved the above described <br />project on and has made the following determinations regarding the above described project: <br />1. LJ The project will have a significant effect on the environment. <br />❑ The project will NOT have a significant effect on the environment <br />Notice of Determination <br />75D-189 <br />FORM "F" <br />