Laserfiche WebLink
<br />EXHIBIT 4 <br />4 <br /> <br /> <br />State of California – The Resources Agency <br />DEPARTMENT OF PARKS AND RECREATION <br />CEQA Compliance Certification Form <br /> <br />GRANTEE: <br />Project Name: <br />Project Address: <br />Is CEQA complete? Yes No Is completing CEQA a PROJECT SCOPE item? Yes No <br />What document was filed, or is expected to be filed for this project’s CEQA analysis: <br />__________________________________ <br />Date complete/expected to be completed: ___________________ <br /> <br /> Notice of Exemption (attach recorded copy if filed) <br /> Notice of Determination (attach recorded copy if filed) <br /> Other: <br /> <br />If CEQA is complete, and a Notice of Exemption or Notice of Determination was not filed, attach <br />a letter from the Lead Agency explaining why, certifying the project has complied with CEQA <br />and noting the date that the project was approved by the Lead Agency. <br />Lead Agency Contact Information <br />Agency Name: <br />Contact Person: <br />Mailing Address: <br />Phone: ( ) Email: <br /> <br />Certification: <br />I hereby certify that the above referenced Lead Agency has complied or will comply with the <br />California Environmental Quality Act (CEQA) and that the project is described in adequate and <br />sufficient detail to allow the project’s construction or acquisition. <br />I further certify that the CEQA analysis for this project encompasses all aspects of the work to <br />be completed with grant funds. <br /> <br />AUTHORIZED REPRESENTATIVE Signature Date <br />Print Name and Title <br /> <br />FOR OGALS USE ONLY <br />CEQA Document Date Received PO Initials <br />NOE NOD <br />