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• ENVIRONMENTAL CHECKLIST FORM <br /> I. BACKGROUND <br /> A. Name of Proponent: State Water Resources Control Board, Bill Heredi ° <br /> B. Address and Phone Number of Proponent: Division of Water Oualiry. 9011? Street 2nd Floor <br /> Sacramento CA 94244-2120 (916) 657-0570 <br /> C. Date Checklist Submitted: <br /> D. Agency Requiring Checklist: <br /> E. Name of Proposal, if Applicable: Statewide General Waste Discharge Requirements for discharges_ <br /> to land from small domestic waste disposal systerns <br /> IL ENVIRONMENTAL IMPACTS <br /> (Explanations are included on attached sheets). <br /> YES MAYBE NO <br /> I. LAND USE AND PLANNING. <br /> Would the proposal: <br /> Sa. Conflict with general plan designation or zoning? 0 0 [�] <br /> b. Conflict with applicable environmental plans or policies 0 0 (�] <br /> adopted by agencies with jurisdiction over the project? <br /> c. Be incompatible with existing land use 0 0 (�] <br /> in the vicinity? <br /> d. Affect agriculture resources or 0 0 (f] <br /> operations(e.g.,impacts to soils or <br /> farmlands or impacts from incompatible <br /> land uses)? <br /> e. Disrupt or divide the physical arrangement 0 0 (�] <br /> of an established community(including a low- <br /> income or minority community)? <br /> 2. GEOLOGIC PROBLEMS. <br /> Would the proposal result in or expose people to potential impacts involving: <br /> a. Fault rupture? 0 0 [J] <br /> b. Seismic ground shaking? 0 0 (]] <br /> c. Seismic ground failure, including liquefaction? 0 0 141 <br /> d. Seiche, tsunami.or volcanic hazard? 0 0 [�] <br /> • e. Landslides or mud flows? 0 0 [�] <br /> -1- <br />