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Version 2/99 editorial corrections May, 05 <br />ENVIRONMENTALAsSESSMENT WORKSHEET <br />Note to preparers: This form and EAW Guidelines are available at http: / /wKNv.eab.state.mn.us The <br />Environmental Assessment Worksheet provides information about a project that may have the potential for <br />significant environmental effects. The EAW is prepared by the Responsible Governmental Unit or its <br />agents to determine whether an Environmental Impact Statement should be prepared. The project proposer <br />must supply any reasonably accessible data for — but should not complete — the final worksheet. If a <br />complete answer does not fit in the space allotted, attach additional sheets as necessary. The complete <br />question as well as the answer must be included if the EAW is prepared electronically. <br />Note to reviewers: Comments must be submitted to the RGU during the 30 -day comment period following <br />notice of the EAW in the EQB Monitor. Comments should address the accuracy and completeness of <br />information, potential impacts that warrant further investigation and the need for an EIS. <br />1. Project title <br />2. Proposer <br />3. RGU <br />Contact person <br />Contact person <br />Title <br />Title <br />Address <br />Address <br />City, state, ZIP <br />City, state, ZIP <br />Phone <br />Phone <br />Fax <br />Fax <br />E -mail <br />E -mail <br />4. Reason for EAW preparation (check one) <br />EIS scoping Mandatory EAW Citizen petition RGU discretion <br />Proposer volunteered <br />If EAW or EIS is mandatory give EQB rule category subpart number and subpart name <br />5. Project location County City /Township <br />'/a '/a Section <br />Township <br />Attach each of the following to the EAW: <br />• County map showing the general location of the project; <br />• U.S. Geological Survey 7.5 minute, 1:24,000 scale map indicating project boundaries <br />(photocopy acceptable); <br />• Site plan showing all significant project and natural features. <br />Range <br />6. Description , <br />a. Provide a project summary of 50 words or less to be published in the EQB Monitor. <br />b. Give a complete description of the proposed project and related new construction. Attach additional <br />sheets as necessary. Emphasize construction, operation methods and features that will cause physical <br />manipulation of the environment or will produce wastes. Include modifications to existing equipment or <br />industrial processes and significant demolition, removal or remodeling of existing structures. Indicate <br />the timing and duration of construction activities. <br />c. Explain the project purpose; if the project will be carried out by a governmental unit, explain the need <br />for the project and identify its beneficiaries. <br />d. Are future stages of this development including development on any outlofs planned or likely to <br />-125- <br />