California Code of Regulations › Title 23 - Waters › Division 3 - State Water Resources Control Board and Regional Water Quality Control Boards › Chapter 27 - Regulations for Implementation of the Environmental Quality Act of 1970 › Appendix A - Environmental Checklist Form

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(To Be Completed By Lead Agency)
Appendix to the State Water Board's CEQA
				  regulations
Cal. Code. Regs., tit. 23, div. 3, ch. 27 sections
				  3720-3781
THE PROJECT
1. Project title:
___________________________
2. Lead agency name and address:
___________________________
___________________________
___________________________
3. Contact person and phone number:
___________________________
4. Project location:
___________________________
5. Description of project: (Describe the whole action
				  involved, including but not limited to later phases of the project, and any
				  secondary, support, or off-site features necessary for its implementation.
				  Attach additional sheets if necessary. The description may be a summary with a
				  reference to other documents that contain the detailed project
				  description.)
EVALUATION OF THE ENVIRONMENTAL IMPACTS IN THE
				  CHECKLIST
1. The board must complete an environmental checklist prior
				  to the adoption of plans or policies for the Basin/208 Planning program as
				  certified by the Secretary for Natural Resources. The checklist becomes a part
				  of the Substitute Environmental Documentation (SED).
2. For each environmental category in the checklist, the
				  board must determine whether the project will cause any adverse impact. If
				  there are potential impacts that are not included in the sample checklist,
				  those impacts should be added to the checklist.
3. If the board determines that a particular adverse impact
				  may occur as a result of the project, then the checklist boxes must indicate
				  whether the impact is "Potentially Significant," "Less than Significant with
				  Mitigation Incorporated," or "Less than Significant."
a. "Potentially Significant Impact" applies if there is
				  substantial evidence that an impact may be significant. If there are one or
				  more "Potentially Significant Impact" entries on the checklist, the SED must
				  include an examination of feasible alternatives and mitigation measures for
				  each such impact, similar to the requirements for preparing an environmental
				  impact report.
b. "Less than Significant with Mitigation Incorporated"
				  applies if the board or another agency incorporates mitigation measures into
				  the SED that will reduce an impact that is "Potentially Significant" to a "Less
				  than Significant Impact." If the board does not require the specific mitigation
				  measures itself, then the board must be certain that the other agency will in
				  fact incorporate those measures.
c. "Less than Significant" applies if the impact will not be
				  significant, and mitigation is therefore not required.
d. If there will be no impact, check the box under "No
				  Impact."
4. The board must provide a brief explanation for each
				  "Potentially Significant," "Less than Significant with Mitigation
				  Incorporated," "Less than Significant," or "No Impact" determination in the
				  checklist. The explanation may be included in the written report described in
				  section 3777(a)(1) or in
				  the checklist itself. The explanation of each issue should identify: (a) the
				  significance criteria or threshold, if any, used to evaluate each question; and
				  (b) the specific mitigation measure(s) identified, if any, to reduce the impact
				  to less than significant. The board may determine the significance of the
				  impact by considering factual evidence, agency standards, or thresholds. If the
				  "No Impact" box is checked, the board should briefly provide the basis for that
				  answer. If there are types of impacts that are not listed in the checklist,
				  those impacts should be added to the checklist.
5. The board must include mandatory findings of significance
				  if required by CEQA Guidelines section
				  15065.
6. The board should provide references used to identify
				  potential impacts, including a list of information sources and individuals
				  contacted.
ISSUES
Potentially Significant
						  Impact
Less Than Significant with
						  Mitigation Incorporated
Less Than
						  Significant Impact
No
						  Impact
I. AESTHETICS -- Would the
						  project:
a) Have a substantial adverse effect on a scenic
						  vista?
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b) Substantially damage scenic resources, including,
						  but not limited to, trees, rock outcroppings, and historic buildings within a
						  state scenic highway?
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c) Substantially degrade the existing visual character
						  or quality of the site and its surroundings?
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d) Create a new source of substantial light or glare
						  which would adversely affect day or nighttime views in the area?
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II. AGRICULTURE AND FOREST RESOURCES:
In determining whether impacts to agricultural
						  resources are significant environmental effects, lead agencies may refer to the
						  California Agricultural Land Evaluation and Site Assessment Model (1997)
						  prepared by the California Dept. of Conservation as an optional model to use in
						  assessing impacts on agriculture and farmland. In determining whether impacts
						  to forest resources, including timberland, are significant environmental
						  effects, lead agencies may refer to information compiled by the California
						  Department of Forestry and Fire Protection regarding the state's inventory of
						  forest land, including the Forest and Range Assessment Project and the Forest
						  Legacy Assessment Project; and forest carbon measurement methodology provided
						  in Forest Protocols adopted by the California Air Resources Boards. Would the
						  project:
a) Convert Prime Farmland, Unique Farmland, or Farmland
						  of Statewide Importance (Farmland), as shown on the maps prepared pursuant to
						  the Farmland Mapping and Monitoring Program of the California Resources Agency,
						  to non-agricultural use?
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b) Conflict with existing zoning for agricultural use,
						  or a Williamson Act contract?
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c) Conflict with existing zoning for, or cause rezoning
						  of, forest land (as defined in Public Resources Code section
						  12220(g)),
						  timberland (as defined by Public Resources Code section
						  4526),
						  or timberland zoned Timberland Production (as defined by Government Code
						  section
						  51104(g))?
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d) Result in the loss of forest land or conversion of
						  forest land to non-forest use?
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e) Involve other changes in the existing environment
						  which, due to their location or nature, could result in conversion of Farmland,
						  to non-agricultural use or conversion of forest land to non-forest
						  use?
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III. AIR QUALITY -- Where available, the significance
						  criteria established by the applicable air quality management or air pollution
						  control district may be relied upon to make the following determinations. Would
						  the project:
a) Conflict with or obstruct implementation of the
						  applicable air quality plan?
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b) Violate any air quality standard or contribute
						  substantially to an existing or projected air quality violation?
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c) Result in a cumulatively considerable net increase
						  of any criteria pollutant for which the project region is non-attainment under
						  an applicable federal or state ambient air quality standard (including
						  releasing emissions which exceed quantitative thresholds for ozone
						  precursors)?
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d) Expose sensitive receptors to substantial pollutant
						  concentrations?
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e) Create objectionable odors affecting a substantial
						  number of people?
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IV. BIOLOGICAL RESOURCES -- Would the project:
a) Have a substantial adverse effect, either directly
						  or through habitat modifications, on any species identified as a candidate,
						  sensitive, or special status species in local or regional plans, policies, or
						  regulations, or by the California Department of Fish and Game or U.S. Fish and
						  Wildlife Service?
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b) Have a substantial adverse effect on any riparian
						  habitat or other sensitive natural community identified in local or regional
						  plans, policies, regulations or by the California Department of Fish and Game
						  or US Fish and Wildlife Service?
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c) Have a substantial adverse effect on federally
						  protected wetlands as defined by Section
						  404 of the Clean Water Act
						  (including, but not limited to, marsh, vernal, pool, coastal, etc.) through
						  direct removal, filling, hydrological interruption, or other means?
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d) Interfere substantially with the movement of any
						  native resident or migratory fish or wildlife species or with established
						  native resident or migratory wildlife corridors, or impede the use of native
						  wildlife nursery sites?
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e) Conflict with any local policies or ordinances
						  protecting biological resources, such as a tree preservation policy or
						  ordinance?
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f) Conflict with the provisions of an adopted Habitat
						  Conservation Plan, Natural Community Conservation Plan, or other approved
						  local, regional, or state habitat conservation plan?
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V. CULTURAL RESOURCES -- Would the project:
a) Cause a substantial adverse change in the
						  significance of a historical resource as defined in §
												15064.5 ?
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b) Cause a substantial adverse change in the
						  significance of an archaeological resource pursuant to §
												15064.5 ?
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c) Directly or indirectly destroy a unique
						  paleontological resource or site or unique geologic feature?
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d) Disturb any human remains, including those interred
						  outside of formal cemeteries?
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VI. GEOLOGY AND SOILS -- Would the project:
a) Expose people or structures to potential substantial
						  adverse effects, including the risk of loss, injury, or death
						  involving:
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i) Rupture of a known earthquake fault, as delineated
						  on the most recent Alquist-Priolo Earthquake Fault Zoning Map issued by the
						  State Geologist for the area or based on other substantial evidence of a known
						  fault? Refer to Division of Mines and Geology Special Publication 42.
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ii) Strong seismic ground snaking?
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iii) Seismic-related ground failure, including
						  liquefaction?
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iv) Landslides?
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b) Result in substantial soil erosion or the loss of
						  topsoil?
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c) Be located on a geologic unit or soil that is
						  unstable, or that would become unstable as a result of the project, and
						  potentially result in on- or off-site landslide, lateral spreading, subsidence,
						  liquefaction or collapse?
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d) Be located on expansive soil, as defined in Table
						  18-1-B of the Uniform Building Code (1994), creating substantial risks to life
						  or property?
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e) Have soils incapable of adequately supporting the
						  use of septic tanks or alternative waste water disposal systems where sewers
						  are not available for the disposal of waste water?
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VII. GREENHOUSE GAS EMISSIONS -- Would the
						  project:
a) Generate Greenhouse gas emissions, either directly
						  or indirectly, that may have a significant impact on the environment?
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b) Conflict with an applicable plan, policy or
						  regulation adopted for the purpose of reducing the emissions of greenhouse
						  gases?
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VIII. HAZARDS AND HAZARDOUS MATERIALS -- Would the
						  project:
a) Create a significant hazard to the public or the
						  environment through the routine transport, use, or disposal of hazardous
						  materials?
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b) Create a significant hazard to the public or the
						  environment through reasonably foreseeable upset and accident conditions
						  involving the release of hazardous materials into the environment?
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c) Emit hazardous emissions or handle hazardous or
						  acutely hazardous materials, substances, or waste within one-quarter mile of an
						  existing or proposed school?
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d) Be located on a site which is included on a list of
						  hazardous materials sites compiled pursuant to Government Code Section
						  65962.5
						  and, as a result, would it create a significant hazard to the public or the
						  environment?
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e) For a project located within an airport land use
						  plan or, where such a plan has not been adopted, within two miles of a public
						  airport or public use airport, would the project result in a safety hazard for
						  people residing or working in the project area?
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f) For a project within the vicinity of a private
						  airstrip, would the project result in a safety hazard for people residing or
						  working in the project area?
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g) Impair implementation of or physically interfere
						  with an adopted emergency response plan or emergency evacuation plan?
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h) Expose people or structures to a significant risk of
						  loss, injury or death involving wildland fires, including where wildlands are
						  adjacent to urbanized areas or where residences are intermixed with
						  wildlands?
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IX. HYDROLOGY AND WATER QUALITY -- Would the
						  project:
a) Violate any water quality standards or waste
						  discharge requirements?
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b) Substantially deplete groundwater supplies or
						  interfere substantially with groundwater recharge such that there would be a
						  net deficit in aquifer volume or a lowering of the local groundwater table
						  level (e.g., the production rate of pre-existing nearby wells would drop to a
						  level which would not support existing land uses or planned uses for which
						  permits have been granted)?
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c) Substantially alter the existing drainage pattern of
						  the site or area, including through the alteration of the course of a stream or
						  river, in a manner which would result in substantial erosion or siltation on-
						  or off-site?
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d) Substantially alter the existing drainage pattern of
						  the site or area, including through the alteration of the course of a stream or
						  river, or substantially increase the rate or amount of surface runoff in a
						  manner which would result in flooding on- or off-site?
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e) Create or contribute runoff water which would exceed
						  the capacity of existing or planned stormwater drainage systems or provide
						  substantial additional sources of polluted runoff?
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f) Otherwise substantially degrade water
						  quality?
g) Place housing within a 100-year flood hazard area as
						  mapped on a federal Flood Hazard Boundary or Flood Insurance Rate Map or other
						  flood hazard delineation map?
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h) Place within a 100-year flood hazard area structures
						  which would impede or redirect flood flows?
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i) Expose people or structures to a significant risk of
						  loss, injury or death involving flooding, including flooding as a result of the
						  failure of a levee or dam?
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j) Inundation by seiche, tsunami, or mudflow?
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X. LAND USE AND PLANNING - Would the project:
a) Physically divide an established community?
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b) Conflict with any applicable land use plan, policy,
						  or regulation of an agency with jurisdiction over the project (including, but
						  not limited to the general plan, specific plan, local coastal program, or
						  zoning ordinance) adopted for the purpose of avoiding or mitigating an
						  environmental effect?
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c) Conflict with any applicable habitat conservation
						  plan or natural community conservation plan?
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XI. MINERAL RESOURCES -- Would the project:
a) Result in the loss of availability of a known
						  mineral resource that would be of value to the region and the residents of the
						  state?
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b) Result in the loss of availability of a
						  locally-important mineral resource recovery site delineated on a local general
						  plan, specific plan or other land use plan?
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XII. NOISE -- Would the project result in:
a) Exposure of persons to or generation of noise levels
						  in excess of standards established in the local general plan or noise
						  ordinance, or applicable standards of other agencies?
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b) Exposure of persons to or generation of excessive
						  groundborne vibration or groundborne noise levels?
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c) A substantial permanent increase in ambient noise
						  levels in the project vicinity above levels existing without the
						  project?
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d) A substantial temporary or periodic increase in
						  ambient noise levels in the project vicinity above levels existing without the
						  project?
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e) For a project located within an airport land use
						  plan or, where such a plan has not been adopted, within two miles of a public
						  airport or public use airport, would the project expose people residing or
						  working in the project area to excessive noise levels?
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f) For a project within the vicinity of a private
						  airstrip, would the project expose people residing or working in the project
						  area to excessive noise levels?
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XIII. POPULATION AND HOUSING -- Would the
						  project:
a) Induce substantial population growth in an area,
						  either directly (for example, by proposing new homes and businesses) or
						  indirectly (for example, through extension of roads or other
						  infrastructure)?
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b) Displace substantial numbers of existing housing,
						  necessitating the construction of replacement housing elsewhere?
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c) Displace substantial numbers of people,
						  necessitating the construction of replacement housing elsewhere?
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XIV. PUBLIC SERVICES
a) Would the project result in substantial adverse
						  physical impacts associated with the provision of new or physically altered
						  governmental facilities, need for new or physically altered governmental
						  facilities, the construction of which could cause significant environmental
						  impacts, in order to maintain acceptable service ratios, response times or
						  other performance objectives for any of the public services:
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Fire protection?
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Police protection?
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Schools?
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Parks?
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Other public facilities?
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XV. RECREATION
a) Would the project increase the use of existing
						  neighborhood and regional parks or other recreational facilities such that
						  substantial physical deterioration of the facility would occur or be
						  accelerated?
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b) Does the project include recreational facilities or
						  require the construction or expansion of recreational facilities which might
						  have an adverse physical effect on the environment?
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XVI. TRANSPORTATION/TRAFFIC -- Would the
						  project:
a) Conflict with an applicable plan, ordinance or
						  policy establishing measures of effectiveness for the performance of the
						  circulation system, taking into account all modes of transportation including
						  mass transit and non-motorized travel and relevant components of the
						  circulation system, including, but not limited to intersections, streets,
						  highways and freeways, pedestrian and bicycle paths, and mass transit?
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b) Conflict with an applicable congestion management
						  program, including, but not limited to level of service standards and travel
						  demand measures, or other standards established by the county congestion
						  management agency for designated roads or highways?
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c) Result in a change in air traffic patterns,
						  including either an increase in traffic levels or a change in location that
						  results in substantial safety risks?
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d) Substantially increase hazards due to a design
						  feature (e.g., sharp curves or dangerous intersections) or incompatible uses
						  (e.g., farm equipment)?
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e) Result in inadequate emergency access?
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f) Conflict with adopted policies, plans, or programs
						  regarding public transit, bicycle, or pedestrian facilities, or otherwise
						  decrease the performance or safety of such facilities?
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XVII. UTILITIES AND SERVICE SYSTEMS -- Would the
						  project:
a) Exceed wastewater treatment requirements of the
						  applicable Regional Water Quality Control Board?
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b) Require or result in the construction of new water
						  or wastewater treatment facilities or expansion of existing facilities, the
						  construction of which could cause significant environmental effects?
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c) Require or result in the construction of new storm
						  water drainage facilities or expansion of existing facilities, the construction
						  of which could cause significant environmental effects?
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d) Have sufficient water supplies available to serve
						  the project from existing entitlements and resources, or are new or expanded
						  entitlements needed?
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e) Result in a determination by the wastewater
						  treatment provider which serves or may serve the project that it has adequate
						  capacity to serve the project's projected demand in addition to the provider's
						  existing commitments?
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f) Be served by a landfill with sufficient permitted
						  capacity to accommodate the project's solid waste disposal needs?
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g) Comply with federal, state, and local statutes and
						  regulations related to solid waste?
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XVIII. MANDATORY FINDINGS OF SIGNIFICANCE
a) Does the project have the potential to degrade the
						  quality of the environment, substantially reduce the habitat of a fish or
						  wildlife species, cause a fish or wildlife population to drop below
						  self-sustaining levels, threaten to eliminate a plant or animal community,
						  reduce the number or restrict the range of a rare or endangered plant or animal
						  or eliminate important examples of the major periods of California history or
						  prehistory?
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b) Does the project have impacts that are individually
						  limited, but cumulatively considerable? ("Cumulatively considerable" means that
						  the incremental effects of a project are considerable when viewed in connection
						  with the effects of past projects, the effects of other current projects, and
						  the effects of probable future projects)?
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c) Does the project have environmental effects which
						  will cause substantial adverse effects on human beings, either directly or
						  indirectly?
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Explanations of Impact Assessment (may also follow
				  checklist sections)
PRELIMINARY STAFF DETERMINATION
[]The proposed project COULD NOT have a significant effect on
				  the environment, and, therefore, no alternatives or mitigation measures are
				  proposed.
[]The proposed project MAY have a significant or potentially
				  significant effect on the environment, and therefore alternatives and
				  mitigation measures have been evaluated.
1. Repealer
				  and new Appendix A filed 1-19-2011; operative 2-18-2011 (Register 2011, No.
				  3).
Note: Authority cited: Section
					 21082,
					 Public Resources Code. Reference: Sections
					 21080(c),
					 21080.1,
					 21080.3,
					 21080.5,
					 21082.1,
					 21083,
					 21083.05,
					 21083.3,
					 21093,
					 21094,
					 21151,
					 Public Resources Code; Sundstrom v. County of Mendocino, 202 Cal.App.3d 296
					 (1988); and Leonoff v. Monterey Board of Supervisors, 222 Cal.App.3d 1337
					 (1990).