2005-06 Consolidated Grants Program

State Water Board Environmental Clearance Checklist for the Grantee or Applicant

This checklist should ensure that all required items are included when project information is submitted to the State Water Resources Control Board for environmental review. All supporting documents indicated on this checklist should be included as part of Attachment Q of the Full Proposal application.

PROJECT and CONTACT INFORMATION (include name and phone numbers for contacts) / Information Included?

Grant Recipient/Project Applicant: Enter Applicant Name Here

Project Name: Enter Project Title Here

County (Or Counties) Where Project Will Occur: Enter County(ies) Here

Project Number: Enter PIN Here

Grant Agreement Number: (To be assigned if selected for funding.

Grant Recipient/Project Applicant’s Staff Contact on Environmental Compliance:

Enter First/Last Name HereEnter Phone Number Here
Program/Grant Manager (for those projects selected for funding, the manager is the Water Board staff overseeing the project)
ENVIRONMENTAL COMPLIANCE (done by governmental agency providing permits or approvals)

Lead Agency (or agencies if compliance needed for both CEQA and NEPA)

Enter Lead Agency Name / Select OneNot ApplicableYesNo
CEQA/NEPA Compliance:
-Yes (if project has either a CEQA or NEPA document) / Yes
-No (If no, explain why the work is not a “project” as defined by CEQA and identify the section that supports this) Enter Explanation Here / No
-Both (if project has both a CEQA and a NEPA document) / Both
Environmental Document: (Please mark which type of document is being submitted for the project)
Initial Study/Negative Declaration (or Environmental Assessment/Finding of No Significant Impact for NEPA compliance) / Select OneNot ApplicableYesNo
Environmental Impact Report (EIR) (or Environmental Impact Statement for NEPA compliance) Enter EIR or EIS Here / Select OneNot ApplicableYesNo
Exemption (if categorical exclusions are used by a federal agency for NEPA compliance, include the list of that agency’s exclusions) / Select OneNot ApplicableYesNo
Categorical: Enter Text
Class: Enter Class Here / Select OneNot ApplicableYesNo
Statutory: Enter Statutory Here
Type of Action: Enter Type of Action Here / Select OneNot ApplicableYesNo
REQUIRED DOCUMENTS

Draft Environmental Document

As a responsible agency, the State Water Board appreciates the opportunity to comment on the draft document. However, the final document must be reviewed before environmental clearance can be given for projects receiving funding.

Final Environmental Document (For exemptions, submit a copy of the Notice of Exemption filed with the applicable county and the Governor’s Office of Planning and Research [OPR].)

/ Select OneNot ApplicableYesNo
Comments and Responses (for CEQA; and as applicable for NEPA) / Select OneNot ApplicableYesNo
Mitigation Monitoring Plan (if applicable) / Select OneNot ApplicableYesNo
Notice of Determination (filed with OPR for CEQA documents; and as applicable for NEPA) / Select OneNot ApplicableYesNo
Resolution(s) identifying the items listed below for CEQA documents: / Select OneNot ApplicableYesNo
Certification of EIR or adoption of the Negative Declaration / Select OneNot ApplicableYesNo
CEQA Findings / Select OneNot ApplicableYesNo
Statement of Overriding Considerations (if applicable) / Select OneNot ApplicableYesNo

Scope of Work for the Project (As part of Attachment G)

/ Select OneNot ApplicableYesNo

Environmental Information Form(click to access on-line form)

/ Select OneNot ApplicableYesNo

April 14, 2006