Cal. Code Regs. Tit. 23, div. 3, ch. 27, art. 6, app A

Current through Register 2024 Notice Reg. No. 44, November 1, 2024

Appendix A

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?	[ ]	[ ]	[ ]	[ ]
b) Substantially damage scenic resources, including, but not limited to, trees,
rock outcroppings, and historic buildings within a state scenic highway?	[ ]	[ ]	[ ]	[ ]
c) Substantially degrade the existing visual character or quality of the site
and its surroundings?	[ ]	[ ]	[ ]	[ ]
d) Create a new source of substantial light or glare which would adversely
affect day or nighttime views in the area?	[ ]	[ ]	[ ]	[ ]
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?
b) Conflict with existing zoning for agricultural use, or a Williamson Act	[ ]	[ ]	[ ]	[ ]
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	[ ]	[ ]	[ ]	[ ]
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?	[ ]	[ ]	[ ]	[ ]
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?
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?	[ ]	[ ]	[ ]	[ ]
b) Violate any air quality standard or contribute substantially to an existing or
projected air quality violation?	[ ]	[ ]	[ ]	[ ]
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)?
d) Expose sensitive receptors to substantial pollutant concentrations?	[ ]	[ ]	[ ]	[ ]
e) Create objectionable odors affecting a substantial number of people?	[ ]	[ ]	[ ]	[ ]
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?
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?
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?
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?
e) Conflict with any local policies or ordinances protecting biological resources,
such as a tree preservation policy or ordinance?	[ ]	[ ]	[ ]	[ ]
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?
V. CULTURAL RESOURCES - Would the project:
a) Cause a substantial adverse change in the significance of a historical resource	[ ]	[ ]	[ ]	[ ]
as defined in §15064.5?
b) Cause a substantial adverse change in the significance of an archaeological	[ ]	[ ]	[ ]	[ ]
resource pursuant to §15064.5?
c) Directly or indirectly destroy a unique paleontological resource or site or unique
geologic feature?	[ ]	[ ]	[ ]	[ ]
d) Disturb any human remains, including those interred outside of formal
cemeteries?	[ ]	[ ]	[ ]	[ ]
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:
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.
ii) Strong seismic ground snaking?	[ ]	[ ]	[ ]	[ ]
iii) Seismic-related ground failure, including liquefaction?	[ ]	[ ]	[ ]	[ ]
iv) Landslides?	[ ]	[ ]	[ ]	[ ]
b) Result in substantial soil erosion or the loss of topsoil?	[ ]	[ ]	[ ]	[ ]
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?
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?
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?
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?	[ ]	[ ]	[ ]	[ ]
b) Conflict with an applicable plan, policy or regulation adopted for the purpose of
reducing the emissions of greenhouse gases?	[ ]	[ ]	[ ]	[ ]
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?	[ ]	[ ]	[ ]	[ ]
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?
c) Emit hazardous emissions or handle hazardous or acutely hazardous materials,	[ ]	[ ]	[ ]	[ ]
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	[ ]	[ ]	[ ]	[ ]
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,	[ ]	[ ]	[ ]	[ ]
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?	[ ]	[ ]	[ ]	[ ]
g) Impair implementation of or physically interfere with an adopted emergency
response plan or emergency evacuation plan?	[ ]	[ ]	[ ]	[ ]
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?
IX. HYDROLOGY AND WATER QUALITY - Would the project:
a) Violate any water quality standards or waste discharge requirements?	[ ]	[ ]	[ ]	[ ]
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)?
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?
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?
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?
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?
h) Place within a 100-year flood hazard area structures which would impede or
redirect flood flows?	[ ]	[ ]	[ ]	[ ]
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?	[ ]	[ ]	[ ]	[ ]
j) Inundation by seiche, tsunami, or mudflow?	[ ]	[ ]	[ ]	[ ]
X. LAND USE AND PLANNING - Would the project:
a) Physically divide an established community?	[ ]	[ ]	[ ]	[ ]
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?
c) Conflict with any applicable habitat conservation plan or natural community
conservation plan?	[ ]	[ ]	[ ]	[ ]
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?	[ ]	[ ]	[ ]	[ ]
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?	[ ]	[ ]	[ ]	[ ]
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?
b) Exposure of persons to or generation of excessive groundborne vibration or
groundborne noise levels?	[ ]	[ ]	[ ]	[ ]
c) A substantial permanent increase in ambient noise levels in the project vicinity
above levels existing without the project?	[ ]	[ ]	[ ]	[ ]
d) A substantial temporary or periodic increase in ambient noise levels in the project
vicinity above levels existing without the project?	[ ]	[ ]	[ ]	[ ]
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?
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?	[ ]	[ ]	[ ]	[ ]
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)?
b) Displace substantial numbers of existing housing, necessitating the construction of
replacement housing elsewhere?	[ ]	[ ]	[ ]	[ ]
c) Displace substantial numbers of people, necessitating the construction of
replacement housing elsewhere?	[ ]	[ ]	[ ]	[ ]
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:
Fire protection?	[ ]	[ ]	[ ]	[ ]
Police protection?	[ ]	[ ]	[ ]	[ ]
Schools?	[ ]	[ ]	[ ]	[ ]
Parks?	[ ]	[ ]	[ ]	[ ]
Other public facilities?	[ ]	[ ]	[ ]	[ ]
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?
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?
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?
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?
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?	[ ]	[ ]	[ ]	[ ]
d) Substantially increase hazards due to a design feature (e.g., sharp curves or
dangerous intersections) or incompatible uses (e.g., farm equipment)?	[ ]	[ ]	[ ]	[ ]
e) Result in inadequate emergency access?	[ ]	[ ]	[ ]	[ ]
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?
XVII. UTILITIES AND SERVICE SYSTEMS - Would the project:
a) Exceed wastewater treatment requirements of the applicable Regional Water
Quality Control Board?	[ ]	[ ]	[ ]	[ ]
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?
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?
d) Have sufficient water supplies available to serve the project from existing
entitlements and resources, or are new or expanded entitlements needed?	[ ]	[ ]	[ ]	[ ]
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?
f) Be served by a landfill with sufficient permitted capacity to accommodate the
project's solid waste disposal needs?	[ ]	[ ]	[ ]	[ ]
g) Comply with federal, state, and local statutes and regulations related to solid
waste?	[ ]	[ ]	[ ]	[ ]
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?
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)?
c) Does the project have environmental effects which will cause substantial adverse
effects on human beings, either directly or indirectly?	[ ]	[ ]	[ ]	[ ]
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.

Cal. Code Regs. Tit. 23, div. 3, ch. 27, art. 6, app A

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).

1. Repealer and new Appendix A filed 1-19-2011; operative 2-18-2011 (Register 2011, No. 3).