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C:\Documents and Settings\rminter\Local Settings\Temporary Internet Files\OLK47\Environmental Information Form.doc10/16/03 CITY OF ANAHEIM ENVIRONMENTAL INFORMATION FORM (To be completed by applicant) Dear Applicant: The City of Anaheim as Lead Agency is required to comply with the California Environmental Quality Act (CEQA). CEQA requires the City to evaluate the potential environmental impacts of your development project. In order to assist us in completing this required environmental review, please provide us with the following information: 1. Project Address or Location: 2. Project Description (describe the entire project, including but not limited to later phases of the project, and any off-site supporting improvements or features necessary for its implementation. Attach additional sheets if necessary): 3. Assessor’s Parcel Number: 4. Name of Property Owner: Address: 5. Name of Authorized Agent: Address: 6. Describe the project site as it exists before the project, including if the site is on filled land or on a slope of ten percent or more and provide information on it’s topography, soil stability, plants and animals, and any cultural, historic or scenic aspects. Provide pictures of the site and describe any existing structures on the site, and their current use. Attach additional sheets if necessary. 7. Other public agencies whose approval is required for permits, financing, participation agreement, etc.). 8. Site size: acres or square feet (if less than an acre). 9. Demolition proposed: No Yes square feet 10. Square feet of new construction: 11. Type, number, stories, and height of new buildings or structures: ---PAGE BREAK--- C:\Documents and Settings\rminter\Local Settings\Temporary Internet Files\OLK47\Environmental Information Form.doc10/16/03 12. Number of on-site parking spaces provided: 13. Tentative development schedule: Start Date: Completion Date: Phasing: 14. Airport Land Use Plan – Is the project site located within an airport land use plan a project may be located within an airport land use plan if it is located within 20,000 feet from the Los Alamitos Armed Forces Reserve Center runway, or within 10,000 feet from the Fullerton Municipal Airport runway) or within the vicinity of a heliport or helistop facility? Complete Sections 15 and 16 for proposed Residential projects only: 15. Single or Multi- Number of Units Sq. Ft. of Units No. of Bedrooms Family Units? 16. Will the proposed residential housing development meet any of the following Article 34 restrictions (low income housing development): Yes No A. Apply for property tax abatement B. Apply for long-term governmental financing C. Provide in excess of 40% of the housing units as low income housing with rent control and occupancy restrictions. Complete Section 17 for proposed Commercial projects only: 17. A. Type of Commercial or Office: B. Is the project oriented: Regionally, City or Neighborhood C. Anticipated hours of operation: D. Estimated employees per shift and number of shifts: E. Location of loading facilities and anticipated hours of loading/delivery operations: 18. If use not Residential, Commercial or Office, indicate type of use below: Manufacturing/Warehousing Institutional Other (Specify): A. Indicate major function: B. Anticipated hours of operation: C. Estimated employees per shift and number of shifts: D. Type, location and square footage of loading facilities: ---PAGE BREAK--- C:\Documents and Settings\rminter\Local Settings\Temporary Internet Files\OLK47\Environmental Information Form.doc10/16/03 Complete Sections 19, 20, and 21 to determine whether a Water Assessment Study and Preliminary Grading/Drainage Plans and/or Preliminary Water Quality Management Plan needs to be submitted as part of the Initial Study. 19. Existing and proposed square feet of all on-site impervious surfaces, including all paved areas paved parking lots and walkways areas, building footprint): Existing Square Feet: Proposed Square Feet: 20. Water Assessment – Does the project include a proposed new development or addition that meets any of the following criteria for a “Large Scale Development” (as defined by Public Resources Code Section 21151.9): Yes No A Residential development of more than 500 dwelling units? B Proposed shopping center or business establishment employing more than 1,000 persons or having more than 500,000 square feet of floor space? C Office building employing more than 1,000 persons or having more than 250,000 square feet of floor space? D Hotel or motel having more than 500 rooms? E Industrial manufacturing or processing plant occupying more than 40 acres or having more than 650,000 square feet of floor area? F Mixed use project that includes one or more of the above-listed projects in items 13(a) through 13(e)? If yes was checked in any of the above boxes, the project may qualify as a “Large Scale Development” and you may need to submit a water assessment study which identifies existing water supply entitlements, water rights, and water service contracts relevant to the water supply for the project (please contact the City of Anaheim Public Utilities Department, Water Engineering Division). 21. Water Quality Management Plan – Does the project include a proposed new development or addition that meets any of the following criteria? Yes No A Residential development of 10 units or more? B Commercial and industrial development (building square footage and paved parking areas) greater than 100,000 square feet? C Automotive repair shop? D Restaurant where the land area of the project site is 5,000 square feet or more (including paved parking areas)? E Hillside development that requires grading of 10,000 square feet or more of surface area where existing slopes exceed 25%? F Parking lot that is 5,000 square feet or more in area and/or which includes 15 or more uncovered parking spaces? If yes was checked in any of the above boxes, preliminary grading/drainage plans and preliminary Water Quality Management Plans need to be submitted as part of this Initial Study (please contact the City of Anaheim Public Works Department, Development Services Division). Please note that upon review of the submitted information, City staff may request additional supporting documentation to assist in the environmental analysis of your project to ensure compliance with CEQA. 22. Name of preparer: Relationship to property owner: Address: Phone No.: Preparer’s signature: Date: