HomeMy WebLinkAboutA-6 Environmental Check list
CITY/RVPUB/2020/313785 FORM "J"
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ENVIRONMENTAL CHECKLIST FORM
1. Project Title: 613 –615 North Azusa Avenue: Dr. Ralph Reyes Professional Dental Practice
2. Lead Agency Name and Address:
City of Azusa Redevelopment Agency, 213 East Foothill Boulevard, Azusa Calif. 91702
3. Contact Person and Phone Number: Jose Amador, Assistant Director of Economic Development/ Redevelopment
(626) 812-5101
4. Project Location: 613 –615 North Azusa Avenue
5. Project Sponsor's Name and Address:
Dr. Ralph Reyes and Jennine Reyes (“Developer”)
105 East Tenth Street
Azusa, Ca 91702
6. General Plan Designation: Central Business District 7. Zoning: Central Business District
8. Description of Project: (Describe the whole action involved, including but not limited to later phases of the
project, and any secondary, support, or off-site features necessary for its implementation. Attach additional sheet(s)
if necessary.)
The proposed project involves the new construction of a mixed-use commercial and multi-family residential
building containing approximately 7,787 square feet of gross building area. The building will house a 3,862 square
foot of medical office space the first floor. The second floor will contain three residential rental units ranging in
size from 890 to 910 square with exterior balconies ranging in size from 30 to 45 square feet. Also included on the
second floor is a large conference room and administrative office that will serve the medical uses on the first floor.
Three parking carports will be provided for the apartment uses at the rear of the property.
9. Surrounding Land Uses and Setting: (Briefly describe the project's surroundings.)
10. Other public agencies whose approval is required (e.g., permits, financing approval, or participation agreement):
ENVIRONMENTAL FACTORS POTENTIALLY AFFECTED:
The environmental factors checked below would be potentially affected by this project, involving at least one impact
that is a "Potentially Significant Impact" as indicated by the checklist on the following pages.
∼ Aesthetics ∼ Agriculture Resources ∼ Air Quality
∼ Biological Resources ∼ Cultural Resources ∼ Geology / Soils
∼ Hazards & Hazardous Materials ∼ Hydrology / Water Quality ∼ Land Use / Planning
∼ Mineral Resources ∼ Noise ∼ Population / Housing
∼ Public Services ∼ Recreation ∼ Transportation / Traffic
∼ Utilities / Service Systems ∼ Mandatory Findings of Significance
CITY/RVPUB/2020/313785 FORM "J"
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DETERMINATION (To be completed by the Lead Agency):
On the basis of this initial evaluation:
∼ I find that the proposed project COULD NOT have a significant effect on the environment, and a
NEGATIVE DECLARATION will be prepared.
∼ I find that although the proposed project could have a significant effect on the environment, there will
not be a significant effect in this case because revisions in the project have been made by or agreed to by
the project proponent. A MITIGATED NEGATIVE DECLARATION will be prepared.
∼ I find that the proposed project MAY have a significant effect on the environment, and an
ENVIRONMENTAL IMPACT REPORT is required.
∼ I find that the proposed project MAY have a "potentially significant" or "potentially significant unless
mitigated" impact on the environment, but at least one effect 1) has been adequately analyzed in an
earlier document pursuant to applicable legal standards, and 2) has been addressed by mitigation
measures based on the earlier analysis as described on attached sheets. An ENVIRONMENTAL
IMPACT REPORT is required, but it must analyze only the effects that remain to be addressed.
∼ I find that although the proposed project could have a significant effect on the environment, because all
potentially significant effects (a) have been analyzed adequately in an earlier EIR or NEGATIVE
DECLARATION pursuant to applicable standards, and (b) have been avoided or mitigated pursuant to
that earlier EIR or NEGATIVE DECLARATION, including revisions or mitigation measures that are
imposed upon the proposed project, nothing further is required.
________________________________
Signature Date
Printed Name For
EVALUATION OF ENVIRONMENTAL IMPACTS:
1) A brief explanation is required for all answers except "No Impact" answers that are adequately supported
by the information sources a lead agency cites in the parentheses following each question. A "No
Impact" answer is adequately supported if the referenced information sources show that the impact
simply does not apply to projects like the one involved (e.g. the project falls outside a fault rupture zone).
A "No Impact" answer should be explained where it is based on project-specific factors as well as general
standards (e.g. the project will not expose sensitive receptors to pollutants, based on a project-specific
screening analysis).
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2) All answers must take account of the whole action involved, including off-site as well as on-site,
cumulative as well as project-level, indirect as well as direct, and construction as well as operational
impacts.
3) Once the lead agency has determined that a particular physical impact may occur, then the checklist
answers must indicate whether the impact is potentially significant, less than significant with mitigation,
or less than significant. "Potentially Significant Impact" is appropriate if there is substantial evidence that
an effect is significant. If there are one or more "Potentially Significant Impact" entries when the
determination is made, an EIR is required.
4) "Negative Declaration: Less Than Significant With Mitigation Incorporated" applies where the
incorporation of mitigation measures has reduced an effect from "Potentially Significant Impact" to a
"Less than Significant Impact." The lead agency must describe the mitigation measures, and briefly
explain how they reduce the effect to a less than significant level (mitigation measures from Section XVII,
"Earlier Analyses," may be cross-referenced).
5) Earlier analyses may be used where, pursuant to the tiering, program EIR, or other CEQA process, an
effect has been adequately analyzed in an earlier EIR or negative declaration. Section 15063(c)(3)(D). In
this case, a brief discussion should identify the following:
a) Earlier Analyses Used. Identify and state where they are available for review.
b) Impacts Adequately Addressed. Identify which effects from the above checklist were within the scope
of and adequately analyzed in an earlier document pursuant to applicable legal standards, and state
whether such effects were addressed by mitigation measures based on the earlier analysis.
c) Mitigation Measures. For effects that are ALess than Significant with Mitigation Measures
Incorporated,@ describe the mitigation measures which were incorporated or refined from the earlier
document and the extent to which they address site-specific conditions for the project.
6) Lead agencies are encouraged to incorporate into the checklist references to information sources for
potential impacts (e.g. general plans, zoning ordinances). Reference to a previously prepared or outside
document should, where appropriate, include a reference to the page or pages where the statement is
substantiated.
7) Supporting Information Sources. A source list should be attached, and other sources used or individuals
contacted should be cited in the discussion.
8) This is only a suggested form, and lead agencies are free to use different formats; however, lead agencies
should normally address the questions from this checklist that are relevant to a project=s environmental
effects in whatever format is selected.
9) The explanation of each issue should identify:
a) the significance criteria or threshold, if any, used to evaluate each question; and
b) the mitigation measure identified, if any, to reduce the impact to less than significance.
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Issues:
Potentially
Significant
Impact
Less Than
Significant
With
Mitigation
Incorporated
Less Than
Significant
Impact
No
Impact
I. AESTHETICS. Would the project:
a) Have a substantial adverse effect on a scenic vista?
∼
∼
∼
∼
b) Substantially damage scenic resources, including,
but not limited to, tress, rock outcroppings, and
historic buildings within a state scenic highway?
∼
∼
∼
∼
c) Substantially degrade the existing visual character
or quality of the site and its surroundings?
∼
∼
∼
∼
d) Create a new source of substantial light or glare
which would adversely affect day or nighttime
views in the area?
∼
∼
∼
∼
II. AGRICULTURE RESOURCES. In determining
whether impacts to agricultural resources are
significant environmental effects, lead agencies may
refer to the California Agricultural Land Evaluation
and Site Assessment Model (1997) prepared by the
California Dept. of Conservation as an optional
model to use in assessing impacts on agriculture and
farmland. Would the project:
a) Convert Prime Farmland, Unique Farmland, or
Farmland of Statewide Importance (Farmland), as
shown on the maps prepared pursuant to the
Farmland Mapping and Monitoring Program of
the California Resources Agency, to non-
agricultural use?
∼
∼
∼
∼
b) Conflict with existing zoning for agricultural use,
or a Williamson Act contract?
∼
∼
∼
∼
c) Involve other changes in the existing
environment which, due to their location or
nature, could result in conversion of Farmland,
to non-agricultural use?
∼
∼
∼
∼
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Issues:
Potentially
Significant
Impact
Less Than
Significant
With
Mitigation
Incorporated
Less Than
Significant
Impact
No
Impact
III. AIR QUALITY. Where available, the significance
criteria established by the applicable air quality
management or air pollution control district may be
relied upon to make the following determinations.
Would the project:
a) Conflict with or obstruct implementation of the
applicable air quality plan?
∼
∼
∼
∼
b) Violate any air quality standard or contribute
substantially to an existing or projected air quality
violation?
∼
∼
∼
∼
c) Result in a cumulatively considerable net increase
of any criteria pollutant for which the project
region is nonattainment under an applicable
federal or state ambient air quality standard
(including releasing emissions which exceed
quantitative thresholds for ozone precursors)?
∼
∼
∼
∼
d) Expose sensitive receptors to substantial pollutant
concentrations?
∼
∼
∼
∼
e) Create objectionable odors affecting a substantial
number of people?
∼
∼
∼
∼
IV. BIOLOGICAL RESOURCES. Would the project:
a) Have a substantial adverse effect, either directly
or through habitat modifications, on any species
identified as a candidate, sensitive, or special
status species in local or regional plans, policies,
or regulations, or by the California Department
of Fish and Game or U.S. Fish and Wildlife
Service?
∼
∼
∼
∼
b) Have a substantial adverse effect on any riparian
habitat or other sensitive natural community
identified in local or regional plans, policies,
regulations or by the California Department of
∼
∼
∼
∼
CITY/RVPUB/2020/313785 FORM "J"
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Issues:
Potentially
Significant
Impact
Less Than
Significant
With
Mitigation
Incorporated
Less Than
Significant
Impact
No
Impact
Fish and Game or U.S. Fish and Wildlife Service?
c) Have a substantial adverse effect on federally
protected wetlands as defined by Section 404 of
the Clean Water Act (including, but not limited
to, marsh, vernal pool, coastal, etc.) through
direct removal, filling, hydrological interruption,
or other means?
∼
∼
∼
∼
d) Interfere substantially with the movement of any
native resident or migratory fish or wildlife
species or with established native resident or
migratory wildlife corridors, or impede the use of
native wildlife nursery sites?
∼
∼
∼
∼
e) Conflict with any local policies or ordinances
protecting biological resources, such as a tree
preservation policy or ordinance?
∼
∼
∼
∼
f) Conflict with the provisions of an adopted
Habitat Conservation Plan, Natural Community
Conservation Plan, or other approved local,
regional, or state habitat conservation plan?
∼
∼
∼
∼
V. CULTURAL RESOURCES. Would the project:
a) Cause a substantial adverse change in the
significance of a historical resource as defined in
' 15064.5?
∼
∼
∼
∼
b) Cause a substantial adverse change in the
significance of an archaeological resource
pursuant to ' 15064.5?
∼
∼
∼
∼
c) Directly or indirectly destroy a unique
paleontological resource or site or unique
geologic feature?
∼
∼
∼
∼
d) Disturb any human remains, including those
interred outside of formal cemeteries?
∼
∼
∼
∼
CITY/RVPUB/2020/313785 FORM "J"
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Issues:
Potentially
Significant
Impact
Less Than
Significant
With
Mitigation
Incorporated
Less Than
Significant
Impact
No
Impact
VI. GEOLOGY AND SOILS. Would the project:
a) Expose people or structures to potential
substantial adverse effects, including the risk of
loss, injury or death involving:
∼
∼
∼
∼
i) Rupture of a known earthquake fault, as
delineated on the most recent Alquist-Priolo
Earthquake Fault Zoning Map issued by the State
Geologist for the area or based on other
substantial evidence of a known fault? Refer to
Division of Mines and Geology Special
Publication 42.
∼
∼
∼
∼
ii) Strong seismic ground shaking?
∼
∼
∼
∼
iii) Seismic-related ground failure, including
liquefaction?
∼
∼
∼
∼
iv) Landslides?
∼
∼
∼
∼
b) Result in substantial soil erosion or the loss of
topsoil?
∼
∼
∼
∼
c) Be located on a geologic unit or soil that is
unstable, or that would become unstable as a
result of the project, and potentially result in on-
or off-site landslide, lateral spreading, subsidence,
liquefaction or collapse?
∼
∼
∼
∼
d) Be located on expansive soil, as defined in Table
18-1-B of the Uniform Building Code (1994),
creating substantial risks to life or property?
∼
∼
∼
∼
e) Have soils incapable of adequately supporting the
use of septic tanks or alternative waste water
disposal systems where sewers are not available
for the disposal of waste water?
∼
∼
∼
∼
VII. HAZARDS AND HAZARDOUS MATERIALS.
CITY/RVPUB/2020/313785 FORM "J"
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Issues:
Potentially
Significant
Impact
Less Than
Significant
With
Mitigation
Incorporated
Less Than
Significant
Impact
No
Impact
Would the project:
a) Create a significant hazard to the public or the
environment through the routine transport, use,
or disposal of hazardous materials?
∼
∼
∼
∼
b) Create a significant hazard to the public or the
environment through reasonably foreseeable
upset and accident conditions involving the
release of hazardous materials into the
environment?
∼
∼
∼
∼
c) Emit hazardous emissions or handle hazardous or
acutely hazardous materials, substances, or waste
within one-quarter mile of an existing or
proposed school?
∼
∼
∼
∼
d) Be located on a site which is included on a list of
hazardous materials sites compiled pursuant to
Government Code section 65962.5 and, as a
result, would it create a significant hazard to the
public or the environment?
∼
∼
∼
∼
e) For a project located within an airport land use
plan or, where such a plan has not been adopted,
within two miles of a public airport or public use
airport, would the project result in a safety hazard
for people residing or working in the project
area?
∼
∼
∼
∼
f) For a project within the vicinity of a private
airstrip, would the project result in a safety
hazard for people residing or working in the
project area?
∼
∼
∼
∼
g) Impair implementation of or physically interfere
with an adopted emergency response plan or
emergency evacuation plan?
∼
∼
∼
∼
h) Expose people or structures to a significant risk of
loss, injury or death involving wildland fires,
∼
∼
∼
∼
CITY/RVPUB/2020/313785 FORM "J"
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Issues:
Potentially
Significant
Impact
Less Than
Significant
With
Mitigation
Incorporated
Less Than
Significant
Impact
No
Impact
including where wildlands are adjacent to
urbanized areas or where residences are
intermixed with wildlands?
VIII. HYDROLOGY AND WATER QUALITY.
Would the project:
a) Violate any water quality standards or waste
discharge requirements?
∼
∼
∼
∼
b) Substantially deplete groundwater supplies or
interfere substantially with groundwater recharge
such that there would be a net deficit in aquifer
volume or a lowering of the local groundwater
table level (e.g., the production rate of pre-
existing nearby wells would drop to a level which
would not support existing land uses or planned
uses for which permits have been granted)?
∼
∼
∼
∼
c) Substantially alter the existing drainage pattern of
the site or area, including through the alteration
of the course of a stream or river, in a manner
which would result in substantial erosion or
siltation on- or off-site?
∼
∼
∼
∼
d) Substantially alter the existing drainage pattern of
the site or area, including through the alteration
of the course of a stream or river, or substantially
increase the rate or amount of surface runoff in a
manner which would result in flooding on- or off-
site?
∼
∼
∼
∼
e) Create or contribute runoff water which would
exceed the capacity of existing or planned storm
water drainage systems or provide substantial
additional sources of polluted runoff?
∼
∼
∼
∼
f) Otherwise substantially degrade water quality?
∼
∼
∼
∼
g) Place housing within a 100-year flood hazard area
as mapped on a federal Flood Hazard Boundary
∼
∼
∼
∼
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Issues:
Potentially
Significant
Impact
Less Than
Significant
With
Mitigation
Incorporated
Less Than
Significant
Impact
No
Impact
or Flood Insurance Rate Map or other flood
hazard delineation map?
h) Place within a 100-year flood hazard area
structures which would impede or redirect flood
flows?
∼
∼
∼
∼
i) Expose people or structures to a significant risk of
loss, injury or death involving flooding, including
flooding as a result of the failure of a levee or
dam?
∼
∼
∼
∼
j) Inundation by seiche, tsunami, or mudflow?
∼
∼
∼
∼
IX. LAND USE AND PLANNING. Would the project:
a) Physically divide an established community?
∼
∼
∼
∼
b) Conflict with any applicable land use plan, policy,
or regulation of an agency with jurisdiction over
the project (including, but not limited to the
general plan, specific plan, local coastal program,
or zoning ordinance) adopted for the purpose of
avoiding or mitigating an environmental effect?
∼
∼
∼
∼
c) Conflict with any applicable habitat conservation
plan or natural community conservation plan?
∼
∼
∼
∼
X. MINERAL RESOURCES. Would the project:
a) Result in the loss of availability of a known
mineral resource that would be of value to the
region and the residents of the state?
∼
∼
∼
∼
b) Result in the loss of availability of a locally-
important mineral resource recovery site
delineated on a local general plan, specific plan
or other land use plan?
∼
∼
∼
∼
XI. NOISE. Would the project result in:
CITY/RVPUB/2020/313785 FORM "J"
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Issues:
Potentially
Significant
Impact
Less Than
Significant
With
Mitigation
Incorporated
Less Than
Significant
Impact
No
Impact
a) Exposure of persons to or generation of noise
levels in excess of standards established in the
local general plan or noise ordinance, or
applicable standards of other agencies?
∼
∼
∼
∼
b) Exposure of persons to or generation of excessive
groundborne vibration or groundborne noise
levels?
∼
∼
∼
∼
c) A substantial permanent increase in ambient
noise levels in the project vicinity above levels
existing without the project?
∼
∼
∼
∼
d) A substantial temporary or periodic increase in
ambient noise levels in the project vicinity above
levels existing without the project?
∼
∼
∼
∼
e) For a project located within an airport land use
plan or, where such a plan has not been adopted,
within two miles of a public airport or public use
airport, would the project expose people residing
or working in the project area to excessive noise
levels?
∼
∼
∼
∼
f) For a project within the vicinity of a private
airstrip, would the project expose people residing
or working in the project area to excessive noise
levels?
∼
∼
∼
∼
XII. POPULATION AND HOUSING. Would the
project:
a) Induce substantial population growth in an area,
either directly (for example, by proposing new
homes and businesses) or indirectly (for example,
through extension of road or other
infrastructure)?
∼
∼
∼
∼
b) Displace substantial numbers of existing housing,
necessitating the construction of replacement
∼
∼
∼
∼
CITY/RVPUB/2020/313785 FORM "J"
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Issues:
Potentially
Significant
Impact
Less Than
Significant
With
Mitigation
Incorporated
Less Than
Significant
Impact
No
Impact
housing elsewhere?
c) Displace substantial numbers of people,
necessitating the construction of replacement
housing elsewhere?
∼
∼
∼
∼
XIII. PUBLIC SERVICES. Would the project:
a) Result in substantial adverse physical impacts
associated with the provision of new or physically
altered governmental facilities, need for new or
physically altered governmental facilities, the
construction of which could cause significant
environmental impacts, in order to maintain
acceptable service ratios, response times or other
performance objectives for any of the public
services:
Fire protection?
∼
∼
∼
∼
Police protection?
∼
∼
∼
∼
Schools?
∼
∼
∼
∼
Parks?
∼
∼
∼
∼
Other public facilities?
∼
∼
∼
∼
XIV. RECREATION. Would the project:
a) Increase the use of existing neighborhood and
regional parks or other recreational facilities such
that substantial physical deterioration of the
facility would occur or be accelerated?
∼
∼
∼
∼
b) Does the project include recreational facilities or
require the construction or expansion of
recreational facilities which have an adverse
physical effect on the environment?
∼
∼
∼
∼
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Issues:
Potentially
Significant
Impact
Less Than
Significant
With
Mitigation
Incorporated
Less Than
Significant
Impact
No
Impact
XV. TRANSPORTATION / TRAFFIC. Would the
project:
a) Cause an increase in traffic which is substantial
in relation to the existing traffic load and capacity
of the street system (i.e., result in a substantial
increase in either the number of vehicle trips, the
volume to capacity ratio on roads, or congestion
at intersections)?
∼
∼
∼
∼
b) Exceed, either individually or cumulatively, a
level of service standard established by the county
congestion management agency for designated
roads or highways?
∼
∼
∼
∼
c) Result in a change in air traffic patterns,
including either an increase in traffic levels or a
change in location that results in substantial
safety risks?
∼
∼
∼
∼
d Substantially increase hazards due to a design
feature (e.g., sharp curves or dangerous
intersections) or incompatible uses (e.g., farm
equipment)?
∼
∼
∼
∼
e Result in inadequate emergency access?
∼
∼
∼
∼
f Result in inadequate parking capacity?
∼
∼
∼
∼
g Conflict with adopted policies, plans, or
programs supporting alternative transportation
(e.g., bus turnouts, bicycle racks)?
∼
∼
∼
∼
XVI0 UTILITIES AND SERVICE SYSTEMS. Would
the project:
a Exceed wastewater treatment requirements of the
applicable Regional Water Quality Control
Board?
∼
∼
∼
∼
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Issues:
Potentially
Significant
Impact
Less Than
Significant
With
Mitigation
Incorporated
Less Than
Significant
Impact
No
Impact
b Require or result in the construction of new
water or wastewater treatment facilities or
expansion of existing facilities, the construction
of which could cause significant environmental
effects?
∼ ∼ ∼ ∼
c Require or result in the construction of new
storm water drainage facilities or expansion of
existing facilities, the construction of which could
cause significant environmental effects?
∼
∼
∼
∼
d Have sufficient water supplies available to serve
the project from existing entitlements and
resources, or are new or expanded entitlements
needed? In making this determination, the City
shall consider whether the project is subject to
the water supply assessment requirements of
Water Code Section 10910, et. seq. (SB 610),
and the requirements of Government Code
Section 664737 (SB 221).
∼
∼
∼
∼
e Result in a determination by the wastewater
treatment provider which serves or may serve the
project that it has adequate capacity to serve the
project=s projected demand in addition to the
provider=s existing commitments?
∼
∼
∼
∼
f Be served by a landfill with sufficient permitted
capacity to accommodate the project=s solid
waste disposal needs?
∼
∼
∼
∼
g Comply with federal, state, and local statutes and
regulations related to solid waste?
∼
∼
∼
∼
XVII0 MANDATORY FINDINGS OF
SIGNIFICANCE
a Does the project have the potential to degrade
the quality of the environment, substantially
reduce the habitat or a fish or wildlife species,
cause a fish or wildlife population to drop below
∼
∼
∼
∼
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Issues:
Potentially
Significant
Impact
Less Than
Significant
With
Mitigation
Incorporated
Less Than
Significant
Impact
No
Impact
self-sustaining levels, threaten to eliminate a plant
or animal community, reduce the number or
restrict the range of a rare or endangered plant or
animal or eliminate important examples of the
major periods of California history or prehistory?
b Does the project have impacts that are
individually limited, but cumulatively
considerable? (ACumulatively considerable@
means that the incremental effects of a project
are considerable when viewed in connection with
the effects of past projects, the effects of other
current project, and the effects of probable future
projects.)
∼
∼
∼
∼
c Does the project have environmental effects
which will cause substantial adverse effects on
human beings, either directly or indirectly?
∼
∼
∼
∼