Page 89 - _ 180314 Special Yucaipa GSA Packet

NOTIFICATION OF LAKE OR STREAMBED ALTERATION

14. ENVIRONMENTAL REVIEW

A. Has a draft or final document been prepared for the project pursuant to the California Environmental Quality Act (CEQA),
National Environmental Protection Act (NEPA), California Endangered Species Act (CESA) and/or federal Endangered
Species Act (ESA)?
□ Yes (Check the box for each CEQA, NEPA, CESA, and ESA document that has been prepared and enclose a copy of each)

□ No (Check the box for each CEQA, NEPA, CESA, and ESA document listed below that will be or is being prepared)

□ Notice of Exemption □ Mitigated Negative Declaration □ NEPA document (type): _________________

□ Initial Study □ Environmental Impact Report □ CESA document (type): _________________
□ Negative Declaration □ Notice of Determination (Enclose) □ ESA document (type): ___________________
□ THP/ NTMP □ Mitigation, Monitoring, Reporting Plan

B. State Clearinghouse Number (if applicable)
C. Has a CEQA lead agency been determined? □ Yes (Complete boxes D, E, and F) □ No (Skip to box 14.G)

D. CEQA Lead Agency
E. Contact Person F. Telephone Number

G. If the project described in this notification is part of a larger project or plan, briefly describe that larger project or plan.

□ Continued on additional page(s)
H. Has an environmental filing fee (Fish and Game Code section 711.4) been paid?
□ Yes (Enclose proof of payment) □ No (Briefly explain below the reason a filing fee has not been paid)

Note: If a filing fee is required, the Department may not finalize a Lake or Streambed Alteration Agreement until the filing fee
is paid.

15. SITE INSPECTION
Check one box only.

□ In the event the Department determines that a site inspection is necessary, I hereby authorize a Department
representative to enter the property where the project described in this notification will take place at any
reasonable time, and hereby certify that I am authorized to grant the Department such entry.

□ I request the Department to first contact (insert name) _______________________________________________
at (insert telephone number) ____________________________________________ to schedule a date and time
to enter the property where the project described in this notification will take place. I understand that this may
delay the Department’s determination as to whether a Lake or Streambed Alteration Agreement is required and/or
the Department’s issuance of a draft agreement pursuant to this notification.

FG2023 Page 8 of 9 Rev. 1/13
Yucaipa Groundwater Sustainability Agency - March 14, 2018 - Page 85 of 226