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HomeMy WebLinkAbout1680 . RESOLUTION NO. 1680 A RESOLUTION OF THE PLANNING COMMISSION OF THE CITY OF ARCADIA. CALIFORNIA, APPROVING CONDmONAL USE PERMIT NO. 02-017 TO OPEN AN INDOOR ROCK CLIMBING GYM AT 305 N. SANTA ANITA A VENUE, UNIT B. WHEREAS, on August 12, 2002, a conditional use pennit application was filed by Jungle Gym Rock Climbing, LLC to open an indoor rock climbing gym (Development Services Department Case No. C.U.P. 02-017) at property commonly known as 305 N. Santa AnitaAvenue, Unit B; and WHEREAS, a public hearing was held on September 24, 2002, at which time all interested persons were given full opportunity to be heard and to present evidence. NOW THEREFORE, THE PLANNING COMMISSION OF THE CITY OF ARCADIA RESOLVES AS FOLLOWS: SECTION 1. That the factual data submitted by the Development Services . Department in the attached report is true and correct. SECTION 2. This Commission finds: I. That the granting of such Conditional Use Pennit will not be detrimental to the public health or welfare, or injurious to the property or improvements in such zone or vicinity because the initial study did not disclose any substantial adverse effects to the area affected by the proposed project. 2. That the use applied for at the location indicated is a proper one for which a Conditional Use Pennit is authorized. 3. That the site for the proposed use is adequate in size and shape to accommodate said use. All yards, spaces, waIls, fences, loading, landscaping and other features including the shared parking with the neighboring business. are adequate to adjust said use with the land and uses in the neighborhood. The proposed project complies with all related zoning requirements as set forth in the Arcadia Municipal Code. 4. That the site abuts streets and highways adequate in width and pavement type to carry the kind of traffic generated by the proposed use. . . . . 5. That the granting of such Conditional Use Permit will not adversely affect the comprehensive General Plan because the land use and current zoning are consistent with the General Plan. 6. That the use applied for will not have a substantial adverse impact on the environment, and that based upon the record as a whole there is no evidence that the proposed project will have any potential for an adverse effect on wildlife resources or the habitat upon which the wildlife depends. SECTION 3. That for the foregoing reasons this Commission grants Conditional Use Permit No. CUP 02-017, to open an indoor rock climbing gym, upon the following conditions: I. The maximum number of patrons at anyone time shall be limited to 25. 2. The use approved by CUP 02-017 is limited to the indoor rock climbing gym. The gym shall be operated and maintained in a manner that is consistent with the proposal and plans submitted and approved for CUP 02-017. 3. A separate sign design review application shall be.submitted for all new signs on the premises. 4. The applicant shall defend, indemnify, and hold harmless the City of Arcadia and its officers, employees, and agents from and against any claim, action, or proceeding against the City of Arcadia, its officers, employees or agents to attack, set aside, void, or annul any approval or condition of approval of the City of Arcadia concerning this project and/or land use decision, including but not limited to any approval or condition of approval of the City Council, Planning Commission, or City Staff, which action is brought within the time period provided for in Government Code Section 66499.37 or other provision of law applicable to this project or decision. The City shall promptly notify the applicant of any claim, action, or proceeding concerning the project and/or land use decision and the City shall cooperate fully in the defense of the matter. The City reserves the right, at its own option, to choose its own attomey to represent the City, its officers, employees, and agents in the defense of the matter. 5. All conditions of approval shall be complied with prior to opening the indoor rock climbing gym. Noncompliance with the plans, provisions and conditions of 2 1680 . approval for CUP 02-017 shall be grounds for immediate suspension orrevocation of any approvals, which could result in the closing of the gym. 6. Approval of CUP 02-017 shall not take effect until the property owner(s), and applicants have executed and filed the Acceptance Form available from the Development Services Department to indicate awareness and acceptance of these conditions of approval. SECTION 4. The decision, findings and conditions contained in this Resolution reflect the Commission's action of September.24, 2002, and the following votes: A YES: Commissioners Baderian, Wen, Hsu, and Olson. NOES: Commissioner Lucas SECTION 5. The Secretary shall certify to the adoption of this Resolution and shall cause a copy to be forwarded to the City Council of the City of Arcadia. I HEREBY CERTIFY that the forgoing Resolution was adopted at a regular meeting of the Planning Commission held on the 8th day of October 2002, by the . following votes: . AYES: NOES: ABSENT: Commissioners Baderian, Hsu, Olson, and Lucas None Commissioner Wen A'9"~ ~r::? <t~~-" ~ -,2: '\ . 'ecretary, Planning ommission City of Arcadia kJk-~ Chairman, Planning Commission City of Arcadia ---------- APPROVED AS TO FORM: ~~~ Stephen P. Deitsch, City Attorney 3 1680 . STAFF REPORT Development Services Department September 24, 2002 TO: FROM: Arcadia City Planning Commission Donna L. Butler, Community Development Administrator By: Thomas P. Li, Assistant Planner SUBJECT: Conditional Use. Permit Application No. CUP 02-017 for a rock climbing gym at 305 N. Santa Anita Avenue, unit B. SUMMARY This Conditional Use Permit application was submitted by Jungle Gym Sport Climbing, LLC, to open a rock climbing gym at 305 N. Santa Anita Avenue, unit B. The Development Services Department is recommending approval of this application, subject to the conditions listed in this report. . GENERAL INFORMATION APPLICANT: Jungle Gym Sport Climbing, LLC (lessee) LOCATION: 305 N. Santa Anita. Avenue, unit B REQUEST: A Conditional Use Permit for an indoor rock climbing gym in a 6,000 sq. ft. warehouse in a C-MI Commercial-Manufacturing zone. Proposed hours of operation are 12:00 noon to 10:00 p.m., Monday through Thursday, and 12:00 noon to 8:00 p.m., Friday through Sunday. SITE AREA: 68,258 square feet (1.57 acre) FRONTAGES: 235 feet along Santa Anita Avenue 291 feet along St. Joseph Street 235 feet along Rolyn Place EXISTING LAND USE & ZONING: The site is bounded by Santa Anita Avenue to the east, St. Joseph . Street to the north, and Rolyn Place to the west. It is' developed with a . . . . warehouse, a restaurant, and two office buildings, zoned C-MI Commercial-Manufacturing. SURROUNDING LAND USES & ZONING: North: Small Animal Hospital - zoned CoM South: Dominico's Restaurant - zoned CoM East: Office/Retail - zoned CoM West: Office - zoned CoM GENERAL PLAN DESIGNATION: Mixed Use (CommerciaVlndustrial) BACKGROUND On April 15, 2002, a business license was issued to the applicant for the manufacturing, warehousing and wholesaling of holds made for rock climbing walls. Tenant improvements of the warehouse include climbing walls for the testing of the holds. The applicant intends to open the use of the climbing walls to the public. Section 9275.1.32 of the Arcadia Municipal Code allows public recreation centers In any zone, subject to a Conditional Use Permit. PROPOSAL AND ANALYSIS The proposal is to open an indoor rock climbing gym in a 6,000 sq.ft. industrial building, of which 1,000 sq.ft. would remain for warehousing purposes. The proposed hours are 12:00 noon to 10:00 p.m., Monday through Thursday, and 12:00 noon to 8:00 p.m., Friday through Sunday. Employees include one manager and two staff members. This will be a members-only facility with the exception of occasional birthday parties, and "guest passes". The applicant estimates a maximum of 10"15 members at anyone time, with a total of 30 visits per day. The majority of the activity is estimated to occur during the evenings, since most patrons will likely visit the facility after regular work hours. The applicant will operate on a reservation basis, if necessary, to limit the number of member visits. Parkinq By code, a recreational center such as a climbing gym is required to provide 1 space per 35 sq.ft. of activity floor area. Under this regulation, the proposed 5,000 sq.ft. of climbing gym area would require 143 parking spaces. Combined with the 1,000 sq.ft. warehouse use which requires 2 spaces, (per 1,000 sq.ft.), the total number of parking spaces required would be 145. CUP 02-017 September 24, 2002 Page 2 . . . Parking Requirements for the subject CommerciaVindustrial Site Tvpe of business Engineering Office Insurance and Church Offices Restaurant (Domenico's) Ind. use at subject bldg. Proposed Climbinq qvm Totals Approx. So. Ft. 4,329 3,128 5,984 1,000 5.000 19,441 Spaces Reouired 17 13 60 2 143 235 Parking Ratio 4/1.000 4/1,000 10/1,000 2/1,000 1/35 12.2/1.000 There are 78 parking spaces on the site. Based on the code requirements, the existing uses require 102 parking spaces. There is a deficiency of 24 spaces. The proposed climbing gym would increase the parking deficiency to 157 spaces. However, the applicant estimates a maximum of 10-15 at any given time,. and will require reservations, if necessary. to regulate the members visiting at any time. Hours of Operation of Other Uses on the Subject Site Business Summit Insurance Church Office Engineering Office Domenico's Restaurant Hours Mon. through Fri., 8 a.m. to 5 p.m. Mon. through Fri., 9 a.m. to 5 p.m. Mon. through Fri., 8 a.m. to 5 p.m. Mon. Closed; Tue. Through Thu., 11 a.m. to 10 p.m.; Fri., 11 a.m. to 11 p.m.; Sat., Noon to 11 p.m.; Sun., Noon to 9 p.m. With the exception of the restaurant, the business hours of the offices on the subject site end at 5:00 p.m. Therefore, many of the parking spaces will become available after that time, which coincides with the anticipated peak hours for the climbing gym. The restaurant is busiest on Fridays and Saturdays, during dinner hours. The applicant anticipates that these would be slow days for the gym as most patrons would be visiting outdoor climbing facilities. CUP 02-017 September 24, 2002 Page 3 . . . The applicant conducted the following parking survey at different times on different days of the week: Friday, September 10 to Wednesday, September 18, 2002 Parking Survey of Available Parking Spaces Mon Wed Fri Sat Sun 8am 72 76 77 77 77 10am 48 52 51 75 64 Noon 52 49 46 53 61 2pm 52 48 55 64 60 4pm 49 53 65 60 65 6pm 74 65 50 51 57 8pm 74 64 42 35 58 10pm 76 70 61 42 68 The survey reflects substantial parking availability during different hours and days of the week. Staff's observations concur with the applicanfs findings. Based on the parking survey it is staff's opinion that by limiting the number of patrons to 25 at anyone time, there will be sufficient parking for the proposed rock climbing gym. Other Code ReQuirements The applicant is required to comply with all development requirements and policies detenmined to be necessary by the ~uilding Official, Fire Marshall, and Community Development Administrator. CEQA Pursuant to the provisions of the California Environmental Quality Act, the Development Services Department prepared an Initial Study for the proposed project. Said Initial Study did not disclose any substantial or potentially substantial adverse change in any of the physical conditions within the area affected by the project including land, air, water, minerals, flora, fauna, ambient noise and objects of historical or aesthetic significance. When considering the record as a whole, there is no evidence that the proposed project will have any potential for adverse effect on wildlife resources or the habitat upon which the wildlife depends. Therefore, a Negative Declaration has been prepared for this project. FINDINGS Section 9275.1.2 of the Arcadia Municipal Code requires that for a Conditional Use Permit to be granted, it must be found that all of the following prerequisite conditions can be satisfied: CUP 02-017 September 24, 2002 . Page 4 . . . 1. That the granting of such Conditional Use Penmit will not be detrimental to the public health or welfare or injurious to the property or improvements in such zone or vicinity. 2. That the use applied for at the location indicated is properly one for which a Conditional Use Penmit is authorized. 3. That the site for the proposed use is adequate in size and shape to accommodate said use, and all yards, spaces, walls, fences, parking, loading, landscaping, and other features required to adjust said use with the land and uses in the neighborhood. 4. That the site abuts streets and highways adequate in width and pavement type to carry the kihd of traffic generated by the proposed use. 5. That the granting of such Conditional Use Penmit will not adversely affect the comprehensive General Plan. RECOMMENDATION The Development Services Department recommends approval of Conditional Use Permit Application No. CUP 02-017, subject to the following conditions: 1. The maximum number of patrons at anyone time shall be limited to 25. 2. The use approved by CUP 02-017 is limited to the indoor rock climbing gym. The gym shall be operated and maintained in a manner that is consistent with the proposal and plans submitted and approved for CUP 02-017. 3. A separate sign design review application shall be submitted for all new signs on the premises. 4. The applicant shall defend, indemnify, and hold harmless the City of Arcadia and its officers, employees, and agents from and against any claim, action, or proceeding against the City of Arcadia, its officers, employees or agents to attack, set aside, void, or annul any approval or condition of approval of the City of Arcadia concerning this project and/or land use decision, including but not limited to any approval or condition of approval of the City Council, Planning Commission, or City Staff, which action is brought within the time period provided for in Government Code Section 66499.37 or other provision of law applicable to this project or decision. The City shall promptly notify the applicant of any claim, action, or proceeding conceming the project and/or land use decision and the City shall cooperate fully in the defense of the matter. The City reserves the right, at its own option, to choose its own attorney to represent the City, its officers, employees, and agents in the defense of the matter. 5. All conditions of approval shall be complied with prior to opening the indoor rock climbing gym. Noncompliance with the plans, provisions and conditions of approval for CUP 02-017 shall be grounds for immediate suspension or revocation of any approvals, which could result in the closing of the gym. CUP 02-017 September 24, 2002 Page 5 . . . 6. Approval of CUP 02-017 shall not take effect until the property owner(s), and applicants have executed and filed the Acceptance Form available from the Development Services Department to indicate awareness and acceptance of these conditions of approval. PLANNING COMMISSION ACTION Approval The Planning Commission should move to approve Conditional Use Permit Application No. CUP 2002-017, file the Negative Declaration, and direct staff to prepare a resolution to approve CUP 02-017 for an indoor rock climbing gym at 305 N.. Santa Anita Avenue, unit B. Denial If the Planning Commission intends to deny this Conditional Use Permit application, the Commission should state the specific reasons for denial and direct staff to prepare the appropriate resolution incorporating the Commission's decision and specific findings. If any Planning Commissioner, or other interested party has any questions or comments regarding this matter prior to the September 24th public hearing, please contact Thomas Li at (626) 574-5447'~ Approved by: ~~ W_11LL. f Corkran W. Nicholson Planning Services Manager Attachments: Land Use Map Aerial Photo & Zoning Map Photos of existing improvements Plans Environmental Documents CUP 02-017 September 24, 2002 Page 6 ~ (333) ~ 1_ N q: 0 100 Feet . (331) ~ (325) (311) ~ q: (300) (311) ~ (15) ~ (305) ST JOSEPH ST ~ (300) ST J( . it ~ (201) (214) 5 It RAS1 N1A cLA sA (155-157-159 (150) (149-151-153 " 1fs 305-8 N Santa Anita Avenue I' , CUP 2002-017 (231) D. N 1aLr..~ ~ 305-8 N Santa Anita Ave D Arcadia I CB~ Zone 1ls DeAnent SalVices Department Wngineering Division Ftep/nd by. R.SGoIlzaIez. AIlgusl2002 3@5c/B M SaJ/lil~~ Af!jJi~~ AW1~fTDaJJ~ CUP 2@@2~@11 . ~ ! IIIII '''- ", " ',F .,,',. ., .1;r'1::~~~.?,?'~'~ 'il-'$,~"ffi'\'j ;\o-J\~ 'I~-'j ,~xr; ~;::~> 'f;:::: ,~- -:t.1lj!1;"'I<i',lii-f....l' '~-"'''''~-' I:\!" ~!S -~, 'i=..;>"ll~ ..:(1l~~ ':1"-.: " !...... ~. ," .~..:. ~~~~.:;.:: \ft~ . \:l'!'.... ~4;; .."""A'" \ ~ !?$~ ....'.'t".i~l "':.6:/%~ If: j''!! de L ;.': r",' tJ t f:i. _~I a _w. aJ<< ..,:.:i::y\t; :1;; ~~~;;' ~- ..RJlt/Q.E Q7.f lOCK amSlNri 6.tXJO 54 fro WA'l'EIWUSf W'K100'1t21' -... a"" I , #,a ~,~', ;~~ ";!f. i:iit..~. ':1'....'" Ifj!; ._~:i;; --~':":. f I~} ~d'- -... 'J<< l} , ","', ~Gi~' . e,~. .~~''':''' .:>t:'<.._." >,~'".... ~",~ , , -... n.. " $lJU1oUJ CDU.U11ONS "/1 1WI/ ENCUJ!iU1lE :':\').''\~ o o u o u ~~~~.' "''''''''''' ~. DEN{T(fS WJDSGV'INC,. - USSlH.4NSSOfUlT III" ~IA N ,I. r . ~' :~ .' " '. '-;, JUIJIiU GYM Il<<K aiMBINGGYU Sm-~.." .. 3l!fll~~~tt: 'e I, ,'"""'"t' Jll*~SIWfi:JlmbIJlg.W: T~~-U~-, 6f6~,.?~ . '.~' "URRENTlUlLl1N5 NIp 0Ci.ll1NJCr.' ..... .;.;;;; !l'Po!~~'11V ~~,~-~; "8,'r~t~'mtl/19 Sl.alb. 9'1'1" ~?I1ftr.~~~.:rQnAcanIbk . ".. " '. .:j' :;.'~~ - ";"<:i - .', '. ..... .. ""..; ;;..~..'" {;. \ -: , #. .. -~ . >j , , \i; j ! 1-10 SCALI:: . . NEGATIVE DECLARATION 1. Name, if any, and a brief description of project: Conditional Use Permit No. CUP 02-017: A Conditional Use Permit (CUP) to open an indoor rock climbing gym in a 6,000 sq. ft. warehouse building in a CoM zone at 305 N. Santa Anita Avenue, Suite B. Proposed hours of operation are 11 am to 9pm, Tuesday- Thursday, 11am to 11pm, Friday and Saturday, and 9am to 6pm, Sunday. 2. Location: 305 N. Santa Anita Avenue, Suite B In the City of Arcadia, County of Los Angeles 3. Entity or person undertaking project: A. X B Other (Private) (1) Name: Jungle Gym Rock Climbing (Lessee) (2) Address: 305 N. Santa Anita Avenue, Suite B Arcadia, CA 91007 The Planning Commission/City Council, having reviewed the Initial Study of this proposed project and having reviewed the written comments received prior to the public meeting of the Planning Commission/City Council, including the recommendation of the City's Staff, does hereby find and declare that the proposed project will not have a significant effect on the environment. A brief statement of the reasons supporting the Planning Commission/City Council's findings are as follows: The Planning Commission/City Council hereby finds that the Negative Declaration reflects its independent judgment. A copy of the Initial Study may be obtained at: Development Services Department Community Development Division 240 W. Huntington Drive Arcadia, CA 91007 (626) 574-5423 The location and custodian of the documents and any other material which constitute the record of proceedings upon which the City based its decision to adopt this Negative Declaration are as follows: Development Services Department Community Development Division 240 W. Huntington Drive Arcadia, CA 91007 (626) 574-5423 . .-1Ho1\1/6 L. I. /J$;.1~TAUr PLAfJJ.ll:R.., Staff . Date Received for Filing Nag Dee 7/02 . File No.: CUP 02-017 CITY OF ARCADIA 240 WEST HUNTINGTON DRIVE ARCADIA, CA 91007 CALIFORNIA ENVIRONMENTAL Q'UALlTY ACT ENVIRONMENTAL CHECKLIST FORM 1. Project Title: A Conditional Use Permit No. CUP 02-017 for an indoor rock climbing gym in a 6,000 sq. ft. warehouse building in a CoM zone. Proposed hours of operation are 11am to 9pm, Tuesday-Thursday, 11am to 11pm, Friday and Saturday, and 9am to 6pm, Sunday. 2. Lead Agency Name & Ad~ress: City of Arcadia Development Services Dept./Community Development Div.lPlanning Services 240 W. Huntington Drive Post Office Box 60021 Arcadia, CA 91066-6021 . 3. Lead Agency Contact Person & Phone Number: Thomas P. Li, Assistant Planner- (626) 574-5447 /fax (626) 447-9173 . 4. Project Location (address): 305 N. Santa Anita Avenue, Suite #B, in the City of Arcadia, County of Los Angeles 5. Project Sponsor's Name, Address & Phone Number: Jungle Gym Rock Climbing 305 N. Santa Anita Avenue, Suite #8 Arcadia, CA 91007 (626) 303-6263 6. General Plan Designation: Mixed Use (CommerciaVlndustrial) 7. Zoning Classification: CoM - Commercial-Manufacturing Form"J" -1- CEQACheckJist 4/99 . . . File No.: CUP 02-017 8. 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 ils implementation,) A Conditional Use Permit (CUP) to open an indoor rock climbing gym in a 6,000 sq. ft. warehouse building in a CoM zone. Proposed hours of operation are 11 am to 9pm, Tuesday-Thursday, 11 am to 11 pm, Friday and Saturday, and 9am to 6pm, Sunday. 9. Surrounding land uses and setting: (Briefly describe the project's surroundings.) North: South: East: West: Animal Hospital Dominico's Restaurant Offices Offices 10. Other public agencies whose approval is required: (e,g" permits, financing approval, participation agreement) The City Building Services, Engineering Division, Fire Marshall, Public Works Services, and Water Services will review the construction plans for the tenant improvements for compliance with all applicable construction and safety codes and will oversee construction and installation of any necessary infrastructure or improvements on-site and/or within and along the public right-of-way. The tenant improvements for the coffee shop will also be reviewed by the Los Angeles County Health Department for compliance with local health codes. ENVIRONMENTAL FACTORS POTENTIALLY AFFECTED: The environmental factors checked below would be potentially affected by this project, involving at least one impact that is a "Potentially Significant Impact" as indicated by the checklist on the following pages: [ ] Aesthetics [ ] Agricultural Resources [ ] Air Quality [ ] Biological Resources [ ] Cultural Resources [ ] Geology I Soils [ ] Hazards & Hazardous Materials [ ] Hydrology I Water Quality [ ] Land Use I Planning [ ] Mineral Resources [ ] Noise [ ] Population I Housing [ ] Public Services [ ] Recreation [ ] Transportation I Traffic [ ] Utilities I Service Systems [ ] Mandatory Findings of Significance FormbJIl -2- CECA Checklist 4/99 File No.: CUP 02-017 . DETERMINATION: (To be completed by the lead Agency) On the basis of this initial evaluation: [X] I find that the proposed project COULD NOT have a significant effect on the environment, and a NEGATIVE DECLARATION will be prepared. [] I find that although the proposed project COULD have a significant effect on the environment, there will not be a significant effect in this case because revisions in the project have been made by or agreed to by the applicant. A MITIGATED NEGATIVE DECLARATION will be prepared. [] I find that the proposed project MAY have a significant effect on the environment, and an ENVIRONMENTAL IMPACT REPORT is required. [] I find that the proposed project MAY have a "potentially significant impact" or "potentially significant unless mitigated impact" on the environment, but at least one effect 1) has been adequately analyzed in an earlier document pursuant to applicable legal standards, and 2) has been addressed by mitigation measures based on the earlier analysis as described on attached sheets. An ENVIRONMENTAL IMPACT REPORT is required, but it must analyze only the effects that remain to be addressed. . [] I find that although the proposed project COULD have a significant effect on the environment, but because all potentially significant effects (a) have been analyzed adequately in an EARLIER ENVIRONMENTAL IMPACT REPORT or NEGATIVE DECLARATION pursuant to applicable standards, and (b) have been avoided or mitigated pursuant to that EARLIER EIR or NEGATIVE DECLARATION, including revisions or mitigation measures that are imposed upon the proposed project, nothing further is required. ~~~. , nature Date: 6-/~-oz Thomas P. Li, Assistant Planner (Printed Name & Title) For: City of Arcadia . Form "J" -3- CEQA Checklist 4/99 . . . File No.: CUP 02-017 EVALUATION OF ENVIRONMENTAL IMPACTS: 1. A brief explanation is required for all answers except "No Impact" answers that are adequately supported by the information sources a lead agency cites in the responses following each question, A "No Impact" answer is adequately supported if the referenced information sources show that the impact simply does not apply to projects like the one involved (e.g., the project falls outside a fault rupture zone). A "No Impact" answer should be explained where it is based on project-specific factors as well as general standards (e.g., the project will not expose sensitive receptors to pollutants, based on a project-specific screening analysis). 2. All answers must take account of the whole action involved,. including off-site as well as on-site, cumulative as well as project-level, indirect as well as direct, and construction as well as operationai impacts. 3. Once the lead agency has determined that a particular physical impact may occur, then the checklist answers must indicate whether the impact is potentially significant, less than significant with mitigation, or lesS man significant. "Potentially Significant Impact" is appropriate if there is substantial evidence that an effect is significant. If there are one or more, "Potentially Significant Impact" entries when the determination is made, an EIR is required. 4. "Negatlv~ Declaration: Less Than Significant With Mitigation Incorporated" applies where the incorporation of mitigation measures has reduced an effecUrom "Potentially Significant Impact" to a "Less Than Significant Impact.' The lead agency must describe the mitigation measures, and briefly explain how they reduce the effect to a less than significant level (mitigation measures from Section XVIII, "Earlier Analyses," must be cross-referenced). 5. Earlier analyses may be used where, pursuant to the tiering, program EIR, or other CEQA process, an effect has been adequately analyzed in an earlier EIR or Negative Declaration. Section 15063(c)(3)(D). In this case, a brief discussion should identify the following: a) Earlier Analyses Used. Identify and state where they are available for review, b) Impacts Adequately Addressed. Identify which effects from the above checklist were within the scope of and adequately analyzed in an earlier document pursuant to applicable legal standards, and state whether such effects were addressed by mitigation measures based on the earlier analysis c) Mitigation Measures. For effects that are "Less Than Significant With Mitigation Measures Incorporated," describe the mitigation measures that were incorporated or refined from the earlier document and the extent to which they address site-specific conditions for the project. 6. lead agencies are encouraged to incorporate into the checklist, references to information sources for potential Impacts (e.g., general plans, zoning ordinances). Reference to a previously prepared or outside document should, where appropriate, include a reference to the page or pages where the statement is substantiated. 7. Supporting Information Sources: A source list should be attached, and other sources, uses or individuals contacted should be cited in the discussion. 8. This is only a suggested form, and lead agencies are free to use different formats; however, lead agencies should normally address the questions from this checklist that are relevant to a project's environmantal effects in whatever format is selected. 9. The explanation of each issue shOUld identify: a) The significant criteria or threshold, if any, used to evaluate each question; and b) The mitigation measure identified, if any, to reduce fhe impactto less than significant. Form!tJIl -4- CEQA Checklist 4/99 . . . File No.: CUP 2002-017 Less Than Significant Potentially Wltn Less Than Slgnlflcant Mitigation Significant No Impact Incorporation Impact Impact I. AESTHETICS - Would the project: a) Have a substantial adverse effect on a scenic vista? [ ] [ ] [] [X] b) Substantially damage scenic resources, including, but not limited to, trees, rock outcroppings, and historic buildings within a state scenic highway? [ ] [ ] [] [X] c) Substantially degrade the existing visual character or Quality of the site and its surroundings? [ ] [ ] [] [X] d) Create a new source of substantial light or glare, which would adversely affect day or nighttime views in the area? [ ] [ ] [] [X] The proposed rock climbing facility will be occupying an existing building in a fully developed area and will not have any of the above impacts. II. AGRICULTURAL 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 Califomia Department of Conservation as an optional model to use in assessing impacts on agriculture and farmland.) 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 Califomia Resources Agency, to non- agricultural use? [ ] [ ] [] [X] b) Conflict with existing zoning for agricultural use, or a Williamson Act contract? [ ] [ ] [] [X] c) Involve other changes in the existing environment, which, due to their location or nature, could result In conversion of Farmland to non-agricultural use? [ ] [ ] [J [XI The proposed rock climbing facility will be occupying an existing building in a fully developed area and will not have any of the above impacts. III. AIR QUALITY - (Where available, the significance criteria established by the applicable air Quaiity management or pollution control district may be relied upon to make the following determinations.) Would the proposal: a) Conflict with or obstruct implementation of the applicable Air Quality Plan? [ ] [ ] [] [X] b) Violate any air quality standard or contribute substantially to an existing or projected air Quality violation? [ I [ I [] [X] 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)? [ ] [ ] [I [X] d) Expose sensitive receptors to substantial pollutant concentrations? [ J [ ] [] [X] e) Create objectionable odors affecting a substantial number of people? [ ] [ I [] [X] The proposed rock climbing facility will be occupying an existing building in a fully developed area and will not have any of the above impacts. Form. J" -5- CEOA Checklist 4/99 . . . File No.: CUP 2002-017 Less Than Significant Potentially With Less Than Significant Mitigetion Significant No Impact Incorporation Impact Impact IV.BIOLOGICAL RESOURCES - Would the project: a) Have a substantial adverse impact, 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 Wildlne Service? [ I [ I [] [Xl b) Have a substantial adverse effect on any riparian habitat or other sensitive natural community identified In local or regional plans, policies, and regulations, or by the Califomia Department of Fish and Game or U. S. Fish and Wildlife Service? [ I [ I [I [XI 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? [ J [ I [I [Xl d) Interfere substantially with the movement of any native resident or migratory fish or wildlne species, or with established native resident or migratory wildlife corridors, or impede the use of native wildlife nursery sites? [ I [ I [I [Xl e) Conflict with any local policies or ordinances protecting biological resources, such as a. tree preservation policy or ordinance? [ I [ I [I [Xl f) Conflict with the provisions of an adopted Habitat Conservation Plan, Natural Conservation Community Plan, or other approved local, regional or state habitat conservation plan? [ I [ 1 [J [Xl The proposed rock climbing facility will be occupying an existing building in a fully developed area and will not have any of the above impacts. V. CULTURAL RESOURCES - Would the project: a) Cause a substantial adverse change in the significance of a historical resource as defined in Section 15064.5? [ ] [ ] [I [Xl b) Cause a substantial adverse change in the signnicance of an archaeological resource pursuant to Section 15064.5? [ .J [ I [I [Xl c) Directly or indirectly destroy a unique paleontological resource or site or unique geologic feature? [ I [ I [] [Xl d) Disturb any human remains, including those interred outside of formal cemeteries? [ I [ I [I [X] The proposed rock climbing facility will be occupying an existing building in a fully developed area and will not have any of the above impacts. 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 shaking? i1i) Seismic-related ground failure, including liquefaction? Iv) landslides [ I [ ] [ ] [ ] [ I [ ] [ ] [ I [ ] [ ] [ I [ I [Xl [Xl [XI [XI Form. J. -6- CEQA Checklist 4/99 . . . Fila No.: CUP 2002-017 less Than Signlflcant Potentially With less Than Slgnlflcant MItigation Significant Impact Incorporejlon Impact [ I [ I [ I NC Impact [X] 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.slte 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 wastewater disposal systems where sewers are not available for the disposal of wastewllter? [ I [ I [I [Xl The proposed rock climbing facility will be occupying an existing building in a fully developed area. The subject location has not been determined to be especially susceptible to any of the above geologic problems and is not within a Seismic Hazard Area identified by the Seismic Hazard Mapping Act. The proposal does not Include any excavation, grading or filling, No unique geolDglc features have been identified at the site. The project is connected to the local sewer system. The project will nDt have any of the above,impacts. [ I [ I [ I (X] [ I [ I [ I [X] VII. HAZARDS AND HAZARDOUS MATERIALS - Would the project: a) Create a significant hazard tD the public or the envirDnment through the routine transport, use, Dr disposal of hazardous materials? [ ] [ I [I [XI b) Create a significant hazard tD the public or the environment through reasonably foreseeable upset and accident conditiDnS involving the release Df hazardous materials into the environment? [ I [ I [I [Xl c) Emil hazardous emissions Dr handle hazardDus or acutely hazardous materials, substances, or waste within one- quarter mile of an existing or propDsed school? [ J [ ] [I [X] d) Be located on a site which is included on a list of hazardous materials sites cDmpiled pursuant to Government Code SectlDn 65962.5 and, as a result, would it create a significant hazard to the public or the environment? [ I [ I [I [Xl 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 Dr public use airport, would the project result in a safety hazard for people residing orworkin9 in the project area? [ I [ I [I [XI 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? [ I [ ] [I [Xl g) Impair Implementation of, or physically Interfere with an adopted emergency response plan or emergency evacuation plan? [J [ I [I [Xl h) ExpDse 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? [ I [ I [J [X] The proposed rock climbing facility will be occupying an existing building in a fully developed area and will not have any of the above impacts. Form' J" -7- CEOA Checklist 4/99 . . . File No,: CUP 2002-017 Less Than Significant Potentially Wltn Less Then Significant Mitigation Significant No Impact Incorporation Impact Impact VIII. HYDROLOGY AND WATER QUALITY - Would the project: a) Violate any water quality standards or waste discharge requirements? [ ] [ ] [] [X] b) Substantially deplete groundwater supplies or inferfere substantially with groundwater recharge such that there would be a net deficit in aquifer volume or a lowering of the local groundwatertable 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 permns have been granted)? [ ] [ ] [] [X] c) Substantially alter the existing drainage pattern of the site or area, including through the aiteration of the course of a stream or river, in a manner that would result in substantial erosion or siltation on- or off-site? [ ] [ J [] [X] 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 that would result in flooding on or off-site? [ ] [ I [J [XI 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? ( ] [ ] [] [X] f) Otherwise substantially degrade water quality [ ] [ ] [] [X] 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? [ ] [ I [] [X] h) Piace structures within a 100-year flood hazard area. which would impede or redirect flood flows? [ ] [ ] [] [X] 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? [ ] [ ] [] [Xl j) Inundation by seiche, tsunami, or mudflow? [ ] [ ] [] [X] The proposed rock climbing facility will be occupying an existing building in a fully developed area, The proposed use will be subject to an Industrial Wastewater Discharge Permit so as not to violate Regional Water Quality Control Board water quality standards or waste discharge requirements. The proposal will not alter absorption rates, drainage pattems, surface runoff, surface water conditions, or ground water conditions. The site is within the Santa Anita Dam Inundation Area, but will not expose people to any additional or increased hazard levels. The project will not have any of the above impacts. IX. LAND USE & PLANNING - Would the project: a) Physically divide an established community? [ ] [ ] [] [Xl 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 miligating an environmental effect? [ ] [ ] [] [X] c) Conflict wnh any applicable habnat conservation plan or natural community conservation plan? [ ] [ ] [] [Xl The proposed rock climbing facility will be occupying an existing building in a fully developed area and will not have any of the above impacts. Form. J- -8- ceOA Chackllst 4/99 . . . File No,: CUP 2002-017 Less Than Significant Potentially With Less Than Slgniflcant Mitigation Significant No Impact Incorporation Impact Impact X. 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? [] [ ] [] [X] b) Result in the loss of availability ofa locally important mineral resource recovery site delineated on a local general plan, specific plan or other land use plan? [ ] [ ] [] [X] The proposed rock climbing facility will be occupying an existing building in a fully developed area and will not have any of the above impacts. XI. 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? [ ] [ ] [] [X] b) Exposure of persons to, or generation of excessive groundborne vibration or groundborne noise levels? [ ] [ ] [] [X] c) A substantial permanent increase in ambient noise levels In the project vicinity above levels existing without the project? [ ] [ ] [] [X] d) A substantial temporary or periodic increase In ambient noise levels in the project vicinity above levels existing wilhout the project? [ ] [ ] [] [Xl 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? [] [ ] [] [X] 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? [ ] [ ] [] [X] The proposed rock climbing facility Will be occupying an existing building in a fully developed area and will not have any of the above impacts. XII. POPULATION & 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)? [ ] [ ] [] [X] b) Displace substantial numbers of existing housing, necessitating the construction of replacement housing elsewhere? [ ] [ ] [] [Xl c) Displace substantial numbers of people, necessitating the construction of replacement housing elsewhere? . [ ] [ ] [] [X] The proposed rock climbing facility will be occupying an existing building in a fully developed area and will not have any of the above impacts. XIII. PUBLIC SERVICES - Would the project result in substantial adverse physical impacts associated with the provision of new or physically altered govemmental facilities, need for new or physically altered ,governmental facilities, the construction of which would cause significant environmental impacts, in order to maintain acceptable. service ratios, response times or other performance objectives for any of the public services: a) Fire protection? [ ] [ ] [] [Xl b) Police protection? [ ] [ ] [] [X] c) Schools? [ ] [ ] [] [X] Form-J" -9- ceOA Checklist 4199 . . . File No,: CUP 2002-017 Less Than Significant Potentially With Less Then Significant Mitigation Slgnllicanl No Impact Incorporation Impact Impact d) Parks? [ ] [ ] [l [Xl e) Other public facilities? [ 1 [ ] [] [Xl The proposed rock climbing facility will be occupying an existing building in a fully developed area ana will not have any of the above impacts. XIV. RECREATION - Would the project: a) 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? [ ] [ ] [] [Xl 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? [ ] [ 1 [] [Xl The proposed rock climbing facility will be occupying an existing building in a fully developed area and will not have' any of the above impacts. XV. TRANSPORTATION I TRAFFIC - Would the project: a) Cause an Increase in traffic that is substantial in relation to the existing traffic load and capacity of the street system (i.e., result in a substantial increase in either the number of vehicle trips, the volume to capacity ratio on roads, or congestion at intersections)? [ ] [ 1 [] [Xl b) Exceed, either individually or cumulatively, a level of service standard established by the county congestion management agency for designated roads or highways? [ ] [ ] [] [Xl c) Result in a change in air traffic pattems, including either an increase in traffic levels or a change in location that resuits in substantial safety risks? [ J [ 1 [] [Xl d) Substantially increase hazards due to a design feature (e.g.. sharp curves or dangerous intersections) or incompatible uses (e.g., farm equipment)? [ ] [ ] [] [Xl e) Result in inadequate emergency access? [ ] [ J [] [Xl f) Result in inadequate parking capacity? [ ] [ ] [Xl [ ] g) Conflict with adopted policies, plans, or programs supporting alternative transportation (e.g., bus turnouts, bicycle racks)? [ 1 [ 1 [] [X] The proposed rock climbing facility will be occupying an existing building in a .fully developed area and will not have any of the above impacts. XVI. UTILITIES & 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 facililies 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? [ 1 [Xl [ ] [ ] [ 1 [Xl [ ] [ 1 [ 1 [X] [ ] [ 1 [ 1 [Xl [ ] [ 1 Form. J- -10- CEOA Checklist 4/99 . . . Ale No,: CUP 2002-017 less Than Significant . Potentially With less Than Signlficent Mitigation Significant No Impact Incorporatlcn Impact Impact e) Result in a determination by the wastewater treatment provider, which serves or may serve the project that ~ has adequate capacity to serve t~e project's projected demand in addition to the providers existing commitments? [ ] [ ] [] [X] f) Be served by a. landfi1l w~h sufficient permitted capacity to accommodate the project's solid waste disposal needs? [ ] [ ] [] [X] g) Comply with federal, state and local statutes and regulations related to solid waste? [ I [ I [J [Xl The proposed rock cllmging facility will be occupying an existing building in a fully developed area and wi1l not have any of the above impacts. XVII. 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? [ I [ I [I [X] b) Does the project have impacts that are individually limited, but cumulatively considerable? ("Cumulatively considerable" means that the incremental eilects 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.) [ ] [ ] [X ] [] c) Does the project have environmental effects, whIch wi1l cause substantial adverse effects on human beings, either directly or indirectly? [ ] [ ] [] [X] The proposed rock climbing facility wi1l be occupying an existing building in a fully developed area and wi1l not have any of the above impacts. XVIII. EARLIER ANALYSES No earlier analyses, and no additional documents were referenced pursuant to the tiering, program EIR, or other CEOA processes to analyze the project. Form "J" -,,- CEQA Checklist 4/99 File No, CITY OF ARCADIA 240 WEST HUNTINGTON DRIVE ARCADIA, CA 91007 (626) 574-5400 ENVIRONMENTAL INFORMATION FORM Date Filed: General Information 1. Name and address of developer or project sponsor: _ (}j~L...€ I"", tv\. (2n, Y ( !... ubi ..5).. 3o~ E> '5. ~"O>.. Jln\. \ I"i'?r I Aoo I -r \ ~ I r ~ 'c::rJ..QD.l.o 2. Address of project (Location): SoS- O. 5. ~A-.J~ prN\1'):),J 1rt.t--AY':l1A-1 c.A- 910611'l .' Name, address and teiephone number of person to be contacted concerning this project: ~~ -=i33 v~ VI~ ~ I ~ 1"'"1 c.I'r C; {b(lD ---1i?b ' '30~. (.,U~ 4, List and describe any other related permits and other public approvals required for this project, including those required by city, regional, state and federal agencies: ~14)1.s"l.. P~I""" -a~~~ ~ ,,~__~ko... -:::f/2.::;:'/lf7-4 5. Zoning:_lDMtv\6\LU ~ I", Mk1'Jv y~1..)1U ~b 6. General Plan Designation:~ IKeD~ lJ5,6 ta<vl M6r2.l:A.f<L / I ~e..J I\L Project Description 7, Proposed use of site (project description): . Jndrnw" ~.v_ e,:.,." ""'~ ~fI^ Site Size:_l.POOo Sq, Ft. I Acre(s) .a. 9. Square footage per building: ~0111> 10. Number offloors of construction: - 11. Amount of off-street parking provided: a-;r~i1rlA ~f>A"~a.l 4~ 12. Proposed scheduling of project: _e".rr(,,^~ IJCJ;) /UJ h61;J ~rli~ I~'j' Pl"hfft~ -l-t> O{:IC..K\. -+D ~ ~c..... A..... ""'6 (J.~J 'Z(rO'Z- 13, As'sociated projects: . ,v-a'" ' - 14. Anticipated incremental development: . - 15. If residential, include the number of units, schedule of unit sizes, range of sale prices or rents, and type of household sizes expected: - 16, If commercial, indicate the type, Le. neighborhood, city or regionally oriented, square foota~e of sales area, and loading facilities, hours of operation: _ ~~~ .J\~~'I~..............,.-..re (l..,,~Jrl~...tnr j.. &-yJ" ~ ~ It.l..~''''t). 1 "'IAo- W' 1 "-'*'~. -r- 17. If industrial, indicate type, es1imated employment per shift, and loading facilities: --- 1a. If institutional, indicate the major function, estimated employment per shift, estimated occupancy, loading facilities, and community benefits to be derived from the project: - . 19. If the project involves a variance, conditional use permit or zoning application, state this Clnd indicate clearly why the application is required: c.~ ,()tn^,~ 11.A e;p"a jo:, ..t:::. ~ 'I~ tJ~ . a1jo\~ ~(l.l~ ~O l~o..CN ,~~. EnvironlnfoForm -2- 4/01 20. Are the following items applicable to the project or its effects? Discuss below all items . checked yes (attach additional sheets as necessary). YES. NO o is' 21. Change in existing features of any hills, or substantial alteration of ground contours. Use or disposal of potentially hazardous materials, such as toxic substances, flammable or explosives Substantial change in demand for municipal services (police, fire, water, sewage, etc.) Substantial increase in fossil fuel consumption (electricity, oil, natural gas, etc,) Relationship toa larger project or series of projects . Has a prior environmental impact report been prepared for a program, plan, policy or ordinance consistent with this project? o ~ 34. If you answered YES to question no, 33, may this project cause significant effects on the environment that were not examined in the prior EIR? Environmental Settina O~ O~ O~ 03 0.0 O~ o ~ ~W DlJ. O~ OlJ OQ! 22. 23. 24, 25. 26. , 31. 32. 33. Change in scenic views or vistas from existing residential areas or public lands or roads, 27. 28, Change in pattern, scale or character of general area of project. Significant amounts of solid waste or Iitter~ Change in dust, ash, smoke, fumes or odors in vicinity. Change in ground water quality or quantity, or alteration of existing drainage patterns. Substantial.change in existing noise or vibration levels in the vicinity. Is site on filled land or on any slopes of 10 percent or more? 29. 30. Describe (on a separate sheet) the project site as it exists before the project, including information on topography, soil stability, plants and animals, any cultural, historical or scenic aspects. Describe any existing structures on the site, and the use of the structures. Attach photographs of the site. (Snapshots or Polaroid photos will be accepted.) 35. . EnvtrO(1lnfoFonn -3- 4/01 .6. Describe (on a separate sheet) the surrounding properties, including information on plants, animals, any cultural, historical or scenic aspects, Indicate the type of land uses (residential, cornmercial, etc,), intensity of land use (one-family, apartment houses, shops, department stores, etc.), and scale of development (height, frontage, set-backs. rear yards, etc.). Attach photographs of the vicinity. Snapshots or Polaroid photos will be accepted. Certification I hereby certify that the statements furnished above and in the attached exhibits present the data and information required for this initial evaluation to the best of my ability, and that the facts, statements, and information presented are true and correct to the best of my knowledge and belief, Date -=t/Vt I 6 'l- . ~uQjL (5 gnature) . For ~_ b'4Y'" f?&.Ie. r ~ ~'''' J..,.,,)~ . . EnVironlnfoForm -4- 4/01