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 › Article 6 - Exempt Regulatory Programs › Appendix A

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Environmental Checklist Form
(To Be Completed By Lead Agency)
Appendix to the State Water Board's CEQA regulations
Cal. Code. Regs., tit. 23, div. 3, ch. 27
					 sections3720-3781
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
Less Than
Potentially
Significant
Less Than
Significant
with Mitigation
Significant
No
Impact
Incorporated
Impact
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
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Mapping and Monitoring Program of the California
								Resources Agency, to
non-agricultural use?
b) Conflict with existing zoning for agricultural
								use, or a Williamson Act
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contract?
c) Conflict with existing zoning for, or cause
								rezoning of, forest land
(as defined in Public Resources Code section
								12220(g)), timberland (as defined
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by Public Resources Code section 4526), or
								timberland zoned Timberland
Production (as defined by Government Code section
								51104(g))?
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
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conversion of forest land to non-forest
								use?
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
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state ambient air quality standard (including
								releasing emissions which exceed
quantitative thresholds for ozone
								precursors)?
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
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or regional plans, policies, or regulations, or by
								the California Department of
Fish and Game or U.S. Fish and Wildlife
								Service?
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
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California Department of Fish and Game or US Fish
								and Wildlife Service?
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,
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pool, coastal, etc.) through direct removal,
								filling, hydrological interruption, or
other means?
d) Interfere substantially with the movement of any
								native resident or migratory fish
or wildlife species or with established native
								resident or migratory wildlife
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corridors, or impede the use of native wildlife
								nursery sites?
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
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conservation plan?
V. CULTURAL RESOURCES - Would the
								project:
a) Cause a substantial adverse change in the
								significance of a historical resource
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as defined in §15064.5?
b) Cause a substantial adverse change in the
								significance of an archaeological
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resource pursuant to §15064.5?
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
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the risk of loss, injury, or death
								involving:
i) Rupture of a known earthquake fault, as
								delineated on the most recent
Alquist-Priolo Earthquake Fault Zoning Map issued
								by the State Geologist
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for the area or based on other substantial evidence
								of a known fault? Refer to
Division of Mines and Geology Special Publication
								42.
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
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spreading, subsidence, liquefaction or
								collapse?
d) Be located on expansive soil, as defined in
								Table 18-1-B of the Uniform
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Building Code (1994), creating substantial risks to
								life or property?
e) Have soils incapable of adequately supporting
								the use of septic tanks or
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alternative waste water disposal systems where
								sewers are not available for the
disposal of waste water?
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
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materials into the environment?
c) Emit hazardous emissions or handle hazardous or
								acutely hazardous materials,
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substances, or waste within one-quarter mile of an
								existing or proposed school?
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
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it create a significant hazard to the public or the
								environment?
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,
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would the project result in a safety hazard for
								people residing or working in the
project area?
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
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residences are intermixed with
								wildlands?
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
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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)?
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
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result in substantial erosion or siltation on- or
								off-site?
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
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the rate or amount of surface runoff in a manner
								which would result in flooding
on- or off-site?
e) Create or contribute runoff water which would
								exceed the capacity of existing or
planned stormwater drainage systems or provide
								substantial additional sources of
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polluted runoff?
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
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map?
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
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plan, local coastal program, or zoning ordinance)
								adopted for the purpose of
avoiding or mitigating an environmental
								effect?
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
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of other agencies?
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,
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would the project expose people residing or working
								in the project area to excessive
noise levels?
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
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of roads or other infrastructure)?
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
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significant environmental impacts, in order to
								maintain acceptable service ratios,
response times or other performance objectives for
								any of the public services:
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
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of the facility would occur or be
								accelerated?
b) Does the project include recreational facilities
								or require the construction
or expansion of recreational facilities which might
								have an adverse physical
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effect on the environment?
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
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relevant components of the circulation system,
								including, but not limited to
intersections, streets, highways and freeways,
								pedestrian and bicycle paths, and
mass transit?
b) Conflict with an applicable congestion
								management program, including, but not
limited to level of service standards and travel
								demand measures, or other
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standards established by the county congestion
								management agency for designated
roads or highways?
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
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facilities?
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
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cause significant environmental
								effects?
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
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environmental effects?
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
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demand in addition to the provider's existing
								commitments?
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
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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?
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,
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the effects of other current projects, and the
								effects of probable future projects)?
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.
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).