HomeMy WebLinkAboutNotice of Completion Form- 800 Dubuque MND - 230330Lead Agency:
Project Description: (please use a separate page if necessary)
Present Land Use/Zoning/General Plan Designation:
Economic/Jobs Public Services/Facilities Traffic/Circulation Other: Drainage/Absorption Population/Housing Balance Toxic/Hazardous Cumulative Effects
Coastal Zone Noise Solid Waste Land Use Biological Resources Minerals Soil Erosion/Compaction/Grading Growth Inducement Archeological/Historical Geologic/Seismic Sewer Capacity Wetland/Riparian Air Quality Forest Land/Fire Hazard Septic Systems Water Supply/Groundwater Agricultural Land Flood Plain/Flooding Schools/Universities Water Quality Aesthetic/Visual Fiscal Recreation/Parks Vegetation
Project Issues Discussed in Document:
Water Facilities: Type MGD Other: Recreational: Hazardous Waste: Type Educational: Waste Treatment: Type MGD Industrial: Sq.ft. Acres Employees Power: Type MW Commercial: Sq.ft. Acres Employees Mining: Mineral Office: Sq.ft. Acres Employees Transportation: Type Residential: Units Acres
Development Type:
Community Plan Site Plan Land Division (Subdivision, etc.) Other:
General Plan Element Planned Unit Development Use Permit Coastal Permit General Plan Amendment Master Plan Prezone Redevelopment General Plan Update Specific Plan Rezone Annexation
Local Action Type:
Mit Neg Dec Other: FONSI Neg Dec (Prior SCH No.) Draft EIS Other: Early Cons Supplement/Subsequent EIR EA Final Document CEQA: NOP Draft EIR NEPA: NOI Other: Joint Document
Document Type:
Airports: Railways: Schools:
Within 2 Miles: State Hwy #: Waterways:
Assessor's Parcel No.: Section: Twp.: Range: Base:
Longitude/Latitude (degrees, minutes and seconds): ° ′ ″ N / ° ′ ″ W Total Acres:
Cross Streets: Zip Code:
Project Location: County: City/Nearest Community:
City: Zip: County:
Mailing Address: Phone:
Contact Person:
Notice of Completion & Environmental Document Transmittal
Mail to: State Clearinghouse, P.O. Box 3044, Sacramento, CA 95812-3044 (916) 445-0613 For Hand Delivery/Street Address: 1400 Tenth Street, Sacramento, CA 95814
Project Title:
SCH #
Note: The State Clearinghouse will assign identification numbers for all new projects. If a SCH number already exists for a project (e.g. Notice of Preparation or previous draft document) please fill in. Revised 2010
Appendix C
Revised 2010
Reviewing Agencies Checklist
Lead Agencies may recommend State Clearinghouse distribution by marking agencies below with and "X". If you have already sent your document to the agency please denote that with an "S". Air Resources Board Office of Historic Preservation
Boating & Waterways, Department of Office of Public School Construction
California Emergency Management Agency Parks & Recreation, Department of
California Highway Patrol Pesticide Regulation, Department of
Caltrans District # Public Utilities Commission
Caltrans Division of Aeronautics Regional WQCB #
Caltrans Planning Resources Agency
Central Valley Flood Protection Board Resources Recycling and Recovery, Department of
Coachella Valley Mtns. Conservancy S.F. Bay Conservation & Development Comm.
Coastal Commission San Gabriel & Lower L.A. Rivers & Mtns. Conservancy
Colorado River Board San Joaquin River Conservancy
Conservation, Department of Santa Monica Mtns. Conservancy
Corrections, Department of State Lands Commission
Delta Protection Commission SWRCB: Clean Water Grants
Education, Department of SWRCB: Water Quality
Energy Commission SWRCB: Water Rights
Fish & Game Region # Tahoe Regional Planning Agency
Food & Agriculture, Department of Toxic Substances Control, Department of
Forestry and Fire Protection, Department of Water Resources, Department of
General Services, Department of
Health Services, Department of Other:
Housing & Community Development Other:
Native American Heritage Commission
Local Public Review Period (to be filled in by lead agency)
Starting Date Ending Date
Lead Agency (Complete if applicable):
Consulting Firm: Applicant:
Address: Address:
City/State/Zip: City/State/Zip:
Contact: Phone:
Phone:
Signature of Lead Agency Representative: Date:
Authority cited: Section 21083, Public Resources Code. Reference: Section 21161, Public Resources Code.