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INITIAL STUDY <br />NOTE: The following is a sample form that may be tailored by the Lead Agency to satisfy project <br />circumstances. It may be used to meet the requirements for an initial study when the criteria set forth in the State and <br />Local CEQA Guidelines have been met. Substantial evidence of potential impacts that are not listed on this form must <br />also be considered. The sample questions in this form are intended to encourage thoughtful assessment of impacts, and <br />do not necessarily represent thresholds of significance. <br />1. Project Title: <br />2. Lead Agency Name and Address: <br />3. Contact Person and Phone Number: <br />4. Project Location: <br />5. Project Sponsor's Name and Address: <br />6. General Plan Designation: 7. Zoning: <br />8. Description of Project: (Describe the whole action involved, including but not limited to later phases of the <br />project, and any secondary, support, or off -site features necessary for its implementation. Attach additional <br />sheet(s) if necessary.) <br />9. Surrounding Land Uses and Setting: (Briefly describe the project's surroundings.) <br />10. Other public agencies whose approval is required (e.g., permits, financing approval, or participation agreement): <br />11. Have California Native American tribes traditionally and culturally affiliated with the project area requested <br />consultation pursuant to Public Resources Code section 21080.3.1? If so, is there a plan for consultation that <br />includes, for example, the determination of significance of impacts to tribal cultural resources, procedures <br />regarding confidentiality, etc.? <br />Note: Conducting consultation early in the CEQA process allows tribal govenunents, lead agencies, and project <br />proponents to discuss the level of environmental review, identify and address potential adverse impacts to tribal <br />cultural resources, and reduce the potential for delay and conflict in the environmental review process. (See <br />Public Resources Code section 21080.3.2.) Information may also be available from the California Native <br />American Heritage Commission's Sacred Lands File per Public Resources Code section 5097.96 and the <br />California Historical Resources Information System administered by the California Office of Historic <br />Preservation. Please also note that Public Resources Code section 21082.3(c) contains provisions specific to <br />confidentiality. <br />Initial Study Form Page 1 of 15 FORM "J" <br />75D-199 <br />