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HomeMy WebLinkAboutSEPA EPIC-23-87 - CITY OF TUKWILA / PARKS AND RECREATION - FOSTER GOLF COURSE MAINTENANCE FACILITYFOSTER GOLF COURSE MAINTENANCE FACILITY OFFICE & EQUIPMENT STORAGE SPACE 13900 INTERURBAN AVE. S. EPIC -23 -87 40" City of Tukwila PLANNING DEPARTMENT ?6200 Southcenter Boulevard Tukwila, Washington 98188 (206) 433 -1849 /908 • TO STATE OF WASHINGTON DEPARTMENT OF ECOLOGY ADDRESS ENVIRONMENTAL REVIEW MAIL STOP PV -11 OLYMPIA, WA 98504 ATTENTION KAREN BEATTY DATE OCTOBER 19, 1987 REGARDING FOSTER GOLF COURSE - EPIC -23 -87 HALVORSEN /LINDELL - EPIC -24 -87 PARKING LOT 3E+ ST IIS) EPIC 25-87 WE ARE SENDING YOU THE FOLLOWING Attached Q Under separate cover COPIES DESCRIPTION 3 DFCIARATTON nF NnN5TGNTFICANCE THESE ARE TRANSMITTED 3 FNVTRONMFNTAI rNECK]TSTS Q For approval Q For review and comment XQ( For your use and information Q As requested Q Other COMMENTS ENCLOSED PLEASE FIND ENCLOSED .31 DNiSiAFNVTQfNMFNTAI curio I$TS.FoQ THE ABOVE NAMED PROJECTLSL_ SHOULD YOU HAVE ANY QIIFSTTONS nR fFSTRF ANY FURTHER IDIFORMATION, P1 FASF CAI 1 AT 433 -1R4Q_ SIGNED JOANNE JOHNSON (23 /P4.LTRANS) AFFIDAVIT I, JOANNE JOHNSON J Notice of Public Hearing [( Notice of Public Meeting [� Board of Adjustment Agenda Packet J Board of Appeals Agenda Packet 0 Planning Commission Agenda Packet J Short Subdivision Agenda Packet O Notice of Application for Shoreline Management Permit El Shoreline Management Permit OF DISTRIBUTION hereby declare that: X Xr Determination of Nonsignificance Q Mitigated Determination of Non - significance O Determination of Significance and Scoping Notice Q Notice of Action [� Official Notice [[ Other [[ Other was mailed to each of the following addresses on OCTOBER 19, 1987 , 19 . STATE OF WASHINGTON DEPARTMENT OF ECOLOGY ENVIRONMENTAL REVIEW MAIL STOP PV -11 OLYMPIA, WA 98504 ATTN: KAREN BETTY Name of Project File Number Fp /C— c,23 WAC 197 -11 -970 DETERMINATION OF NONSIGNIFICANCE Description of Proposal FOSTER GOLF COURSE MANTENANCE FACILITY Proponent CITY OF TUKWILA PARKS DEPARTMENT Location of Proposal, including street address, if any SOUTHWEST CORNER OF FOSTER GOLF COURSE APPROXIMATELY 300 FEET EAST OF INTERURBAN AVENUE SOUTH. ADDRESS: 13900 INTERURBAN AVENUE SOUTH Lead Agency: City of Tukwila File No. EPIC-23-87 The lead agency for this proposal has determined that it does not have a probable significant adverse impact on the environment. An environmental impact statement (EIS) is not required under RCW 43.21C.030(2)(c). This decision was made after review of a completed environmental checklist and other information on file with the lead agency. This information is available to the public on request. There is no comment period for this DNS [[ This DNS is issued under 197 -11- 340(2). Comments must be submitted by . The lead agency will not act on this proposal for 15 days from the date below. Responsible Official Rick Beeler Position /Title Address 6200 Southcenter Boulevard, Tuktra 98188 Date Signature Planning Director Phone 433 -1845 You may appeal this determination to the City Clerk at City Hall, 6200 Southcenter Boulevard, Tukwila, WA 98188 no later than 10 days from the above date by written appeal stating the basis of the appeal for specific factual objections. You may be required to bear some of the expenses for an appeal. Copies of the procedures for SEPA appeals are available with the City Clerk and Planning Department. FM.DNS CITY OF TUKWILA CN CENTRAL PERMIT SYSTEM ENVIRONMENTAL REVIEW ROUTING FORM: EPIC - 23 -67 FILE i31-/v -L- TO: n BLDG n PLNG n P.W. n FIRE n POLICE n P & R PROJECT Tv,fk -t' yo/6 Cov.,j e /Ytfifr,% 14rrCe 7wc: /,/ LOCATION 1-'1k/ yor Covife FILE NO. 97-/O -. DATE TRANSMITTED /o/4„/87 RESPONSE REQUESTED BY /0///2/6'7 STAFF COORDINATOR Re6ec6a_ RESPONSE RECEIVED THE ATTACHED ENVIRONMENTAL CHECKLIST WAS RECEIVED REGARDING THIS PROJECT. PLEASE REVIEW AND COMMENT BELOW TO ADVISE THE RESPONSIBLE OFFICIAL REGARDING THE THRESHOLD DETERMINATION. THE ENVIRONMENTAL REVIEW FILE IS AVAILABLE IN THE PLANNING DEPART- MENT THROUGH THE ABOVE STAFF COORDINATOR. COMMENTS REGARDING THE PROJECT YOU WISH CARRIED TO THE PLANNING COMMISSION, BOARD OF ADJUSTMENT, AND CITY COUNCIL SHOULD BE MADE ON THE ATTACHED CENTRAL PERMIT SYSTEM ROUTING FORM. ITEM COMMENT DATE 7.0 2-1e7• COMMENTS PREPARED BY 42,1e- C.P.S. Form 11 CITY OF TUKWILA CENTRAL PERMIT SYSTEM CN EPIC" 23-67 FILE .53 "7- /v - ENVIRONMENTAL REVIEW ROUTING FORM: TO: [j BLDG [j PLNG ,l./ 1 P.W. FIRE n POLICE n P & R � /l PROJECT I%7°`6 Co tf /Pr ks -7 (t. w Li/iy/ FILE NO. 97- /o -tee LOCATION /fk/ yo1, Cou fe DATE TRANSMITTED ,o/4, % 7 STAFF COORDINATOR ReheceA RESPONSE REQUESTED BY /0/ /2 /97 RESPONSE RECEIVED THE ATTACHED ENVIRONMENTAL CHECKLIST WAS RECEIVED REGARDING THIS PROJECT. PLEASE REVIEW AND COMMENT BELOW TO ADVISE THE RESPONSIBLE OFFICIAL REGARDING THE THRESHOLD DETERMINATION. THE ENVIRONMENTAL REVIEW FILE IS AVAILABLE IN THE PLANNING DEPART- MENT THROUGH THE ABOVE STAFF COORDINATOR. COMMENTS REGARDING THE PROJECT YOU WISH CARRIED TO THE PLANNING COMMISSION, BOARD OF ADJUSTMENT, AND CITY COUNCIL SHOULD BE MADE ON THE ATTACHED CENTRAL PERMIT SYSTEM ROUTING FORM. ITEM COMMENT DATE /p /Jp. dry COMMENTS PREPARED BY vr._.. C.P.S. Form 11 • CITY OF TUKWILA CN CENTRAL PERMIT SYSTEM EPIC- 23-67 FILE X31 -fo - ENVIRONMENTAL REVIEW ROUTING FORM: TO: n BLDG n PLNG n P.W. n FIRE ri POLICE [j P & R PROJECT yo /6 Co ✓T,j e /• /f r? kcrtafr1 aG, r / LOCATION iskt 7o/, Cod/,re FILE NO. 87-/0 -e DATE TRANSMITTED /0/% %7 RESPONSE REQUESTED BY /0 /z/d7 STAFF COORDINATOR Re6ecc,. /x RESPONSE RECEIVED THE ATTACHED ENVIRONMENTAL CHECKLIST WAS RECEIVED REGARDING THIS PROJECT. PLEASE REVIEW AND COMMENT BELOW TO ADVISE THE RESPONSIBLE OFFICIAL REGARDING THE THRESHOLD DETERMINATION. THE ENVIRONMENTAL REVIEW FILE IS AVAILABLE IN THE PLANNING DEPART- MENT THROUGH THE ABOVE STAFF COORDINATOR. COMMENTS REGARDING THE PROJECT YOU WISH CARRIED TO THE PLANNING COMMISSION, BOARD OF ADJUSTMENT, AND CITY COUNCIL SHOULD BE MADE ON THE ATTACHED CENTRAL PERMIT SYSTEM ROUTING FORM. ITEM COMMEN DATE COMMENTS PREPARED BY C.P.S. Form 11 CITY OF TUKWILA CN CENTRAL PERMIT SYSTEM EPIC— 23-67 FILE ?I- /v -fx_ ENVIRONMENTAL REVIEW ROUTING FORM: TO: [j BLDG 1J PLNG [] P.W. ri FIRE 0 POLICE n P & R PROJECT 766 Cov,f'e /'f 7 kptan [z. 7WC4 / y LOCATION Tsk' for CO r//fe' FILE NO. 97- /o DATE TRANSMITTED /0/(0/57 RESPONSE REQUESTED BY /042 f6'% STAFF COORDINATOR ,'ef ecc4 ? x RESPONSE RECEIVED THE ATTACHED ENVIRONMENTAL CHECKLIST WAS RECEIVED REGARDING THIS PROJECT. PLEASE REVIEW AND COMMENT BELOW TO ADVISE THE RESPONSIBLE OFFICIAL REGARDING THE THRESHOLD DETERMINATION. THE ENVIRONMENTAL REVIEW FILE IS AVAILABLE IN THE PLANNING DEPART- MENT THROUGH THE ABOVE STAFF COORDINATOR. COMMENTS REGARDING THE PROJECT YOU WISH CARRIED TO THE PLANNING COMMISSION, BOARD OF ADJUSTMENT, AND CITY COUNCIL SHOULD BE MADE ON THE ATTACHED CENTRAL PERMIT SYSTEM ROUTING FORM. ITEM COMMENT �o car,Ir DATE ( (/ 3 D/-G-) COMMENTS PREPARED BY C.P.S. Form 11 CITY OF TUKWILA CENTRAL PERMIT SYSTEM CN EPIC- 2i -67 FILE i31 -/v -/. ENVIRONMENTAL REVIEW ROUTING FORM: TO: n BLDG PLNG [] P.W. [ FIRE ri POLICE n P & R PROJECT 7o /6 Coal• e �7'lf��rkYraoce LOCATION ifk 7or Cov /fe FILE NO. 97-10 -.e DATE TRANSMITTED /0/4 %7 RESPONSE REQUESTED BY leViZ fv'% STAFF COORDINATOR Rehecc'g. / c RESPONSE RECEIVED THE ATTACHED ENVIRONMENTAL CHECKLIST WAS RECEIVED REGARDING THIS PROJECT. PLEASE REVIEW AND COMMENT BELOW TO ADVISE THE RESPONSIBLE OFFICIAL REGARDING THE THRESHOLD DETERMINATION. THE ENVIRONMENTAL REVIEW FILE IS AVAILABLE IN THE PLANNING DEPART- MENT THROUGH THE ABOVE STAFF COORDINATOR. COMMENTS REGARDING THE PROJECT YOU WISH 'CARRIED TO THE PLANNING COMMISSION, BOARD OF ADJUSTMENT, AND CITY COUNCIL SHOULD BE MADE ON THE ATTACHED CENTRAL PERMIT SYSTEM ROUTING FORM. ITEM COMMENT / A Fi ;A ,Qeitiff'nvle.'t, eP"r✓►i ! iC- ee$'lk -ed tCr ro u) 57; r 5. (/ )v) DATE COMMENTS PREPARED BY C.P.S. Form 11 A. BACKGROUND Control No. Epic File No. Fee $100.00 Receipt No. 9T7 ENVIRONMENTAL CHECKLIST ►1' AIIANN �.L>u or ru tfr 1. Name of proposed project, if applicable: 2. Name of applicant: 3. Address .f • and phone number of applicant and contact person: x765( UNIVt/?1`(Ill'r OS'— i.: • ilk, V 11 _ 4. Date checklist prepared: • -?.4631 /'"1 5. Agency requesting Checklist: City of Tukwila 6. Proposed timin. or schedule (including phasing, if applicable): J. 6.0 #1-1 0 t' J 7. Do you have any plans for future additions, expansion, or further activity related to or connected with this proposal? If yes, explain. 1■1161j 8. List any environmental information you know about that has been prepared, or will be prepared, directly related to this roposal. IiirCa14,4110/1 AS f -to /fir U 1 ti t /1���' Arplie„A n s0 tauG A 1� 9. Do you know whether applications are pending for governmental approvals of other proposals directly affecting the property covered by your proposal? If yes, explain. 10. List any government approvals or permits that will be needed for your proposal. 11. Give brief, complete description of your proposal, including the proposed use and the size of the project and site. There are several questions later in thi. checklist that ask you to describe certain aspects of your proposal. You do no. need to repeat those answers on this page. Section E requires a complete . description of the objectives and alternatives of your proposal and should not be summarized here. 'ub tqv - 4 A c -'1'L•v1.1 •CAr49 �IL A - 1-u ! 1 r* - C / A•1 %(.. -� -� _ �� �. • 11.4'm,JAIJcm r44 d?7 - q. ar [1) tJ OE- r- . 12. Location of the proposal. Give sufficient information for a person to understand the precise location of your proposed project, including a street address, if any, and section, township, and range, if known. If a proposal would occur over a range of area, provide the range or boundaries of the site(s). Provide a legal description, site plan, vicinity map, and topographic map, if reasonably available. While you should submit any plans required by the agency, you are not required to duplicate maps or detailed plans submitted with any permit applica- tions related to this checklist. _ i U 1ztS�.rJ ... ZG�l. uM 3$� i1 ��• i,-r rJ . t_. W 5r t r71.& - - meEws tyro uR AL Altos'. 13. Does the proposal lie within an area designated on the City's Comprehensive Land Use Policy Plan Map as environmentally sensitive? No TO BE COMPLETED BY APPLICANT B. ENVIRONMENTAL ELEMENTS 1. Earth a. General description of the site (circle one):`. rolling, hilly, steep slopes, mountainous, other b. What is the steepest slope on the site (approximate percent slope)? /2 c. What general types of soils are found on the site (for example, clay, sand, gravel, peat, muck)? If you know the classification of agricultural soils, specify them and note any prime farmland. d. Are there surface indications or history of unstable soils in the immediate vicinity? If so, describe. e. Describe the purpose, type, and approximate quanti- ties of any filling or grading proposed. Indicate source of fill. l3 _ _ /L !/ as L .i/ f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe. r-o ii Gd l ol.S rripur 150-,c2s1 AO ea) pooject- g. About what percent of the site will be covered with impervious surfaces after project construction (for example, asphalt or buildings)? : r t' o(t''i WI u. to kt.__LAd UI auS su m Evaluation for Agency Use Only Evaluation for Agency Use Only h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any: cja/J - Goufizoc. 61J10a -01J Iu .ej ,ar/oIJ drvtA4 • - LIJOhci -OrAi AW2 2. Air • _ Ji :'. . !L — • . a. What types of emissions to the the proposal (i.e., dust, industrial wood smoke) during the project is completed? describe and give approximate 11- , 0 air would result from automobile odors, construction and when If any, generally quantities if known. IJG�_Uj lIJ5r b. Are there any off -site sources of emissions or odor that may affect your proposal? If so, generally describe. 1,(j c. Proposed measures to reduce or control emissions or other impacts to air, if any: 15u1142 Wjc.Q li-Y�I Uro ra U L- 1-1 461740, 1=1M65 WILL. 130 015s74,,4'm7 3. Water a. Surface: 1) Is there any surface water body on or in the immediate vicinity of the site (including year - round and seasonal streams, saltwater, lakes, ponds, wetlands)? If yes, describe type and provide names. If appropriate, state what s eam or river it flows into. U WA M 2) Will the project require any work over, in, or adjacent to (within 200 feet) the described waters? If yes, phase describe and attach available plans. N 3) Estimate the amount of fill and dredge material that would be placed in or removed from surface water or wetlands and indicate the area of the site that would be affected. Indicate the source of fill material. Nolier 4) Will the proposal require surface water withdrawals or diversions? Give general description, purpose and approximate quan- tities, if known. 5) Does the proposal lie within a 100 -year floodplain? If so, note location on the site p1 an. ►�Fs c,vItl ` tK1. # L?AflnN 1s s- o pL off- 443,6•u- /00 %Maiz. aarr PtAI /.l 6) Does the proposal involve any discharges of waste materials to surface waters? If so, describe the type of waste and anticipated volume of discharge. h]() Evaluation for Agency Use Only Evaluation for Agency Use Only b. Ground: 1) Will ground water be withdrawn, or will water be discharged to ground water? Give general description, purpose and approximate quan- tities, if known. 2) Describe waste materials that will be discharged into the ground from septic tanks or other sour- ces, if any (for example: Domestic sewage; industrial, containing the following chemicals...; agricultural; etc.) Describe the general size of the system, the number of such systems, the number of houses to be served (if applicable), or the number of animals or humans . the system(s) are expected to serve. c. Water Runoff (including storm water): 1) Describe the source of runoff (including storm water) and method of collection and disposal, if any (include quantities, if known). Where will this water flow? Will this water flow into other waters? If so, describe. •f:./ t.L 10 bpit vf5 _ -- _- s Aar, cep- 4 u4Jo ,e-1- P I LSLA 113444 07 A 1( 2raq U S 1 L (U.,. ee2P SSG "jam Ad nat./ U tz _� t L gogi,e)11�C xoi o skin y ut Evaluation for Agency Use Only 2) Could waste materials enter ground or surface waters? If so, generally describe. d. Proposed measures to reduce or control surface, ground, and runoff water impacts, if any: `3 U�1'�7�-ZUIJC� • 4. Plants a. Check or circle types of vegetation found on the site: _ deciduous tree: alder, maple, aspen, other _ evergreen tree: fir, cedar, pine, other 1 shrubs S Pte+ grass �al.� _ pasture crop or grain '� _ wet soil plants: cattail, buttercup, bullrush, skunk cabbage, other _ water plants: water lily, eelgrass, milfoil, other other types of vegetation b. What kind and amount of vegetation will be removed or altered? c. List threatened or endangered species known to be on or near the site. d. Proposed landscaping, use of native plants, or other, measures to preserve or enhance vegetation on the site, if any: re5t U/It_t_ _(..601-1W1-4— IP 1114 (1 ni/&. 5. Animals a. Circle any birds and animals which have been observed on or near the site or are known to be on or near the site: birds: eagle, songbirds other: mammals: deer, bear, elk, beaver, other: fish: bass, 41mon rou herring, shellfish, other: b. List any threatened or endangered species known to be on or near the site. c. Is the site part of a migration route? If so, explain. d. Proposed measures to preserve or enhance wildlife, if any: MtN014 Urn Evaluation for Agency Use Only Evaluation for Agency Use Only 6. Energy and Natural Resources a. What kinds of energy .electric,, natural gas oil, wood stove, solor) wi •e use o meet the completed project's energy needs? Describe whether it will be used for heattiinng, manufacturing, etc. (l'—i' FOIATi • peFutzeot_. b. Would your project affect the potential use of solar energy by adjacent properties? If so, generally describe. c. What kinds of energy conservation features are included in the plans of this proposal? List other proposed measures to reduce or control energy impacts, if any: l ALL) 0657 dJ WORM eP P3 7. Environmental Health a. Are there any environmental health hazards, including exposure to toxic chemicals, risk of fire and explosion, spill, or hazardous waste, that could occur as a result of this proposal? If describe. so, Tc z. izr7,141 i s I Sot - 1 1) Describe special emergency services that might be required. 0 s 45gs 2) Proposed measures to reduce or control environ- mental health hazards, if any: _ '( Sf1 Gull t� t Ldly173l . Wi4J e5.44) 15.40/7709...)/ -10- b. Noise Evaluation for Agency Use Only 1) What types of noise exist in the area which may affect your project (for example: traffic, equipm nt, operation, other)? 2) What types and levels of noise would be created by or associated with the project on a short - term or a long -term basis (for example: traf- fic, construction, operation, other)? Indicate what hours noise would come from the site. lr else c71 4 /1141 r747fl J 14 itles — 1Vi &VIP) IJAMc N.)6 , /�rq)�12CSSo1Z . pU z. nj6 Pa^ .rp fertin IJAINbf•)LDW t►dlse l.f S — 011_ 1 rv4 3) Proposed measures to reduce or control noise impacts, if any: Most- 4ct►vt t i6' c� I s W l LL- fve Hod snen ids fits Bt4P6y 8. Land and Shoreline Use a. What is the current use of the site and adjacent properties? s1- h b. Has the site been used for agriculture? If so, describe. c. Describe any structures on the site. � IJJ0 eLtAPHOUSW t . Evaluation for Agency Use Only d. Will any structures be demolished? If so, what? e. What is the current zoning classification of the site ?_ .-•� It D14-t�/,Y.�C___ f. What is the current comprehensive plan designation of the site? c01%.4J 114C. g. If applicable, what is the current horeline master program designation of the site? f4/4 h. Has any part of the site been classified as an "environmentally sensitive" area? If so, specify. i. Approximately how many people would reside or work in the completed project? G4--� 02A �'� 15— ZO PURAIJ o C�7�� S sQN Approximately how many people would the completed project displace?� • k. Proposed measures to avoid or reduce displacement pac. ts if any: 1. Proposed measures to ensure the proposal is com- patible with existing and projected land uses and plans, if any: rriez_)-r. (mu, GoMpLj- wi jest use -12- 9. Housing a. Approximately how many units would be provided, if any? Indicate whether high, middle, or low - income housing? J b. Approximately how many units, if any, would be eli- minated? Indicate whether high, middle, or low - Ire housing. ‘, c. Proposed measures to reduce or control housing impacts, if any: JgoLLIG 10. Aesthetics a. What is the tallest height of any proposed structure(s), not including antennas; what is the principal exterior building material(s) proposed? b. What views in the immediate vicinity would be altered or obstructed? ONE c. Proposed measures to reduce or control aesthetic impacts, if any: IN IMp/�GTO� - rT7 st4r -gou 1uh,1.6 Evaluation for Agency Use Only 11. Light and Glare Evaluation for Agency Use Only a. What type of light or glare will the proposal produce? What time of day would it mainly occur? 14 "1 4L— LI �1 rwG? gf 4;444' 1Af tom CNl liffizawrieAnYiller b. Could light or glare from the finished project be a safety hazard or interfere with views? 1`/O c. What existing off -site sources of light or glare may affect your proposal? KlopE d. Proposed measures to reduce or control light and glare impacts, if any:=� r r .-1' Wain" sUi �/9i1 Ko j t 12. Recreation a. What designed and informal recreational oppor- tunities are in the immediate vicinity? Ii i IS b. Would the proposed project displace any existing . recreational uses? If so, describe. c. Proposed measures to reduce or control impacts on recreation, including recreation opportunities to be provided by the project or applicant, if any: -14- Evaluation for Agency Use Only 13. Historic and Cultural Preservation a. Are there any places or objects listed on, or pro- posed for, national, state, or local preservation registers known to be on or next to the site? If so, generally describe. 0 b. Generally describe any landmarks or evidence of historic, archaeological, scientific, or cultural importance known to be on or next to the site. c. Proposed measures to reduce or control impacts, if any: 14. Transportation a. Identify public streets and highways serving the site, and describe proposed accss to the existing street system. Show on site plans, if any. V . S'--- f1 cum, Li 1 E _L ;G b. Is the site currently served by public transit? If not, what is the approximate distance to the nearest transit stop? '' c. How many parking spaces would the completed project have? How many would the project eliminate? Evaluation for Agency Use Only d. Will the proposal require any new roads or streets, or improvements to existing roads or streets, not including driveways? If so, generally describe (indicate whether public or private). �.�o e. Will the project use (or occur in the immediate vicinity of) water, rail, or air transportation? If so, generally describe. f. How many vehicular trips per day would be generated by the completed project? If known, indicate when peak volumes would occur. IL lx g. Proposed measures to reduce or control transpor- tation �impacts, if any: 15. Public Services a. Would the project result in an increased need for public services (for example: fire protection, police protection, health care, schools, other)? If so, generally describe. b. Proposed measures to reduce or control direct imilLon public services, if any. Evaluation for Agency Use Only 16. Utilities a. Circle utilities" currently available at the site: �ec�ric�t atural ! . a er,) " efuse service) e ep one anitary sewer, s , other. b. Describe the utilities that are proposed for the project, the utility providing the service, and the general construction activities on the site or in the immediate vicinity which might be needed. _ ice_ Pv��' �r 1 -�___ ►� -{fit v PH-cue- c'r'c 1uckik C. Signature The above answers are true and complete to the b -st of my knowledge. I understand that the le .. ag cy is relying on them to make its dec'si Signature: Date Submitted: PLEASE CONTINUE TO THE NEXT PAGE.