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ERC_Docket_12C_Env_Checklist_171130
PLANNINGDIVISIONENVIRONMENTALCHECKLISTCityofRentonPlanningDivision1055SouthGradyWay-Renton,WA98057Phone:425-430-7200Fax:425-430-7231PURPOSEOFCHECKLIST:TheStateEnvironmentalPolicyAct(SEPA),Chapter43.21CRCW,requiresallgovernmentalagenciestoconsidertheenvironmentalimpactsofaproposalbeforemakingdecisions.AnEnvironmentalImpactStatement(EIS)mustbepreparedforallproposalswithprobablesignificantadverseimpactsonthequalityoftheenvironment.Thepurposeofthischecklististoprovideinformationtohelpyouandtheagencyidentifyimpactsfromyourproposal(andtoreduceoravoidimpactsfromtheproposal,ifitcanbedone)andtohelptheagencydecidewhetheranEISisrequired.INSTRUCTIONSFORAPPLICANTS:Thisenvironmentalchecklistasksyoutodescribesomebasicinformationaboutyourproposal.Governmentalagenciesusethischecklisttodeterminewhethertheenvironmentalimpactsofyourproposalaresignificant,requiringpreparationofanEIS.Answerthequestionsbriefly,withthemostpreciseinformationknown,orgivethebestdescriptionyoucan.Youmustanswereachquestionaccuratelyandcarefully,tothebestofyourknowledge.Inmostcases,youshouldbeabletoanswerthequestionsfromyourownobservationsorprojectplanswithouttheneedtohireexperts.Ifyoureallydonotknowtheanswer,orifaquestiondoesnotapplytoyourproposal,write“donotknow”or“doesnotapply”.Completeanswerstothequestionsnowmayavoidunnecessarydelayslater.Somequestionsaskaboutgovernmentalregulations,suchaszoning,shoreline,andlandmarkdesignations.Answerthesequestionsifyoucan.Ifyouhaveproblems,thegovernmentalagenciescanassistyou.Thechecklistquestionsapplytoallpartsofyourproposal,evenifyouplantodothemoveraperiodoftimeorondifferentparcelsofland.Attachanyadditionalinformationthatwillhelpdescribeyourproposaloritsenvironmentaleffects.Theagencytowhichyousubmitthischecklistmayaskyoutoexplainyouranswersorprovideadditionalinformationreasonablyrelatedtodeterminingiftheremaybesignificantadverseimpact.-1-06/09C:\Users\jsubia\AppData\Local\Microsoft\Windows\TemporaryInternetFiles\Content.Outlook\FM1HI8XC\envchlst-SmallCellandDASUndergrounding(002).docx USEOFCHECKLISTFORNONPROJECTPROPOSALS:Completethischecklistfornon-projectproposals,eventhoughquestionsmaybeanswered“doesnotapply.”INADDITION,completetheSUPPLEMENTALSHEETFORNONPROJECTACTIONS(partD).Fornon-projectactions(actionsinvolvingdecisionsonpolicies,plansandprograms),thereferencesinthechecklisttothewords“project,”“applicant,”and“propertyorsite”shouldbereadas“proposal,”“proposer,”and“affectedgeographicarea,”respectively.A.BACKGROUNDC1.Nameofproposedproject,ifapplicable:RevisionstoRentonMunicipalCodeUndergroundingRegulations,andRentonMunicipalCodeWirelessRegulations—SmallCellWirelessandDistributedAntennaSystems2.Nameofapplicant:CityofRenton3.Addressandphonenumberofapplicantandcontactperson:JenniferHenning:10555.GradyWay,Renton,WA98057,425-430-7286,ihenninci@rentonwa.gov.4.Datechecklistprepared:November29,20175.Agencyrequestingchecklist:CityofRenton6.Proposedtimingorschedule(includingphasing,ifapplicable):NotApplicable(N/A)7.Doyouhaveanyplansforfutureadditions,expansion,orfurtheractivityrelatedtoorconnectedwiththisproposal?Ifyes,explain.N/AListanyenvironmentalinformationyouknowaboutthathasbeenprepared,orwillbeprepared,directlyrelatedtothisproposal.N/A9.Doyouknowwhetherapplicationsarependingforgovernmentalapprovalsofotherproposalsdirectlyaffectingthepropertycoveredbyyourproposal?Ifyes,explain.N/A10.Listanygovernmentalapprovalsorpermitsthatwillbeneededforyourproposal,ifknown.N/A11.Givebrief,completedescriptionofyourproposal,includingtheproposedusesandthesizeoftheprojectandsite.ItisanticipatedthatSection4-6-090oftheRentonMunicipalCodewillbeamendedtoclarifyrequirementsforundergroundingutilitiesandtoclarifywhenexemptionsarepermitted:oClarifythatundergroundingisrequiredforallnewutilityandcommunicationfacilities,unlessexempted.oClarifythatundergroundingisrequiredforoverheadpowerandutilitylinesabuttingdevelopmentsites,whentheprojectisrequiredtoinstallstreetfrontageimprovements.oExemptexistingsinglefamilyhomesfromundergroundingwhenreplacingorupgradingservicepanelswhenexistingwiresrunfromanexistingpoletothehouse,andthatpolehaswiresthatserveothersinglefamilyhomes.-2- oExemptprojectswherereplacementofoverheadwireswouldoccurfor3orfewerspans(4poles),oradistanceoflessthan500feet,unlesspartofanewsitedevelopmentorredevelopmentofasite.ItisanticipatedthatSection4-4-140oftheRentonMunicipalCodewillbeamendedto:oRevisedefinitionstofacilitatedeploymentofsmallcellwirelessfacilitiesoRevisetheZoningUseTableandWirelessRegulationstoallowforsmallcellsinallzonessubjecttoanAdministrativeConditionalUsePermit,exceptthatsmallcellfacilitiescomplyingwithpreferredconcealmenttechniqueswouldbepermittedwithoutaCUP.Preferredconcealmenttechniquesinclude:attachingtobuildings;incorporatingintomarqueesigns;attachingtoorreplacingparkinglotlighting;replacingutilitypolesorstreetlightstoincorporateconcealedfacilities;and,allowforusingofexistingutilitypolesinareasotherthandesigndistrictsandareawhereundergroundingismandated.oAllowforconsiderationofotherconcealmentapproachesthroughthesubmittalofa‘concealmentelementplan’thatwouldallowforotherconcealmentapproachesnotspecificallyaddressedbycodesuchasinformationkiosks,streetfurniture,artwork,wayfinding,etc.oAllowforasingleusepermittobeusedtoapplyforallsmallcellsspacedtoprovidewirelesscoverageinacontiguousarea.12.Locationoftheproposal.Givesufficientinformationforapersontounderstandthepreciselocationofyourproposedproject,includingastreetaddress,ifany,andsection,township,andrangeifknown.Ifaproposalwouldoccuroverarangeofarea,providetherangeorboundariesofthesite(s).Providealegaldescription,siteplan,vicinitymap,andtopographicmap,ifreasonablyavailable.Whileyoushouldsubmitanyplansrequiredbytheagency,youarenotrequiredtoduplicatemapsordetailedplanssubmittedwithanypermitapplicationsrelatedtothischecklist.Theseregulationswouldbecitywide.B.ENVIRONMENTALELEMENTS1.EARTHa.Generaldescriptionofthesite(circleone);flat,rolling,hilly,steepslopes,mountainous,other______________.N/A,non-projectaction.TheCityofRentonhasareasofsteepslopes,somehills,andaplateau,butalsoincludesavalleyarea.b.Whatisthesteepestslopeonthesite(approximatepercentslope?)N/A,non-projectaction.c.Whatgeneraltypesofsoilsarefoundonthesite(forexample,clay,sand,gravel,peat,muck)?Ifyouknowtheclassificationofagriculturalsoils,specifythemandnoteanyprimefarmland.N/A,non-projectactiond.Aretheresurfaceindicationsorhistoryofunstablesoilsintheimmediatevicinity?Ifso,describe.N/A,non-projectaction.e.Describethepurpose,type,andapproximatequantitiesofanyfillingorgradingproposed.Indicatesourceoffill.N/A,non-projectaction.f.Coulderosionoccurasaresultofclearing,construction,oruse?Ifso,generallydescribe.N/A,non-projectaction.-3- g.Aboutwhatpercentofthesitewillbecoveredwithimpervioussurfacesafterprojectconstruction(forexample,asphaltorbuildings)?N/A,non-projectaction.h.Proposedmeasurestoreduceorcontrolerosion,orotherimpactstotheearth,ifany:N/A,non-projectaction.2.AIRa.Whattypesofemissionstotheairwouldresultfromtheproposal(i.e.,dust,automobile,odors,industrialwoodsmoke)duringconstructionandwhentheprojectiscompleted?Ifany,generallydescribeandgiveapproximatequantitiesifknown.N/A,non-projectaction.b.Arethereanyoff-sitesourcesofemissionorodorthatmayaffectyourproposal?Ifso,generallydescribe.N/A,non-projectaction.c.Proposedmeasurestoreduceorcontrolemissionsorotherimpactstoair,ifany:N/A,non-projectaction.3.WATERa.SurfaceWater:1)Isthereanysurfacewaterbodyonorintheimmediatevicinityofthesite(includingyear-roundandseasonalstreams,saltwater,lakes,ponds,wetlands)?Ifyes,describetypeandprovidenames.Ifappropriate,statewhatstreamorriveritflowsinto.N/A,non-projectaction.TheCityofRentonhasasignificantamountofshorelinealongbothLakeWashingtonandtheCedarRiver.Therearealsowetlandsandstreamslocatedinmanylocationsthroughoutthecity.Alllanduseapplicationswillbereviewedandanalyzedforpotentialimpactsatthetimeofapplication.Ifappropriate,projectspecificimpactswillbeaddressedandmitigated.2)Willtheprojectrequireanyworkover,in,oradjacentto(within200feet)thedescribedwaters?Ifyes,pleasedescribeandattachavailableplans.N/A,thisisanon-projectaction.Alllanduseapplicationswillbereviewedandanalyzedforpotentialimpactsatthetimeofapplication.Ifappropriate,projectspecificimpactswillbeaddressedandmitigated.3)Estimatetheamountoffillanddredgematerialthatwouldbeplacedinorremovedfromsurfacewaterorwetlandsandindicatetheareaofthesitethatwouldbeaffected.Indicatethesourceoffillmaterial.N/A,non-projectaction.4)Willtheproposalrequiresurfacewaterwithdrawalsordiversions?Givegeneraldescription,purpose,andapproximatequantitiesifknown.N/A,non-projectaction.5)Doestheproposalliewithina100-yearfloodplain?Ifso,notelocationonthesiteplan.N/A,non-projectaction.6)Doestheproposalinvolveanydischargesofwastematerialstosurfacewaters?Ifso,describethetypeofwasteandanticipatedvolumeofdischarge.N/A,nonprojectaction.b.GroundWater:-4- 1)Willgroundwaterbewithdrawn,orwillwaterbedischargedtogroundwater?Givegeneraldescription,purpose,andapproximatequantitiesifknown.N/A,non-projectaction.2)Describewastematerialthatwillbedischargedintothegroundfromseptictanksorothersources,ifany(forexample:Domesticsewage;industrial,containingthefollowingchemicals...;agricultural;etc.).Describethegeneralsizeofthesystem,thenumberofsuchsystems,thenumberofhousestobeserved(ifapplicable),orthenumberofanimalsorhumansthesystem(s)areexpectedtoserve.N/A,non-projectaction.c.WaterRunoff(includingstormwater):1)Describethesourceofrunoff(includingstormwater)andmethodofcollectionanddisposal,ifany(includequantities,ifknown).Wherewillthiswaterflow?Willthiswaterflowintootherwaters?Ifso,describe.N/A,non-projectaction.2)Couldwastematerialentergroundorsurfacewaters?Ifso,generallydescribe.N/A,non-projectaction.3)Proposedmeasurestoreduceorcontrolsurface,ground,andrunoffwaterimpacts,ifany:N/A,non-projectaction.Ifappropriate,projectspecificimpactswillbeaddressedandmitigated.4.PLANTSa.Checkorcircletypesofvegetationfoundonthesite:Xdeciduoustree:alder,maple,aspen,otherXevergreentree:fir,cedar,pine,otherXshrubsXgrass_____pasture_____croporgrainXwetsoilplants:cattail,buttercup,bulirush,skunkcabbage,other_____waterplants:waterlily,eelgrass,milfoil,other____othertypesofvegetationb.Whatkindandamountofvegetationwillberemovedoraltered?N/A,non-projectaction.c.Listthreatenedorendangeredspeciesknowntobeonornearthesite.N/A.non-projectaction.d.Proposedlandscaping,useofnativeplants,orothermeasurestopreserveorenhancevegetationonthesite,ifany:N/A,non-projectaction.5.ANIMALSa.Circleanybirdsandanimals,whichhavebeenobservedonornearthesiteorareknowntobeonornearthesite:Mammalsrbear,elk,2)other_-5- Fish:bass,salmon,trout,herring,shellfish,other__________________b.Listanythreatenedorendangeredspeciesknowntobeonornearthesite.N/A,non-projectaction.TheCedarRiverispopulatedbysalmonandincludesspawninggrounds.TherearealsoothercreeksandriverswithintheCitythatcontainsalmonandincludespawninggrounds.c.Isthesitepartofamigrationroute?Ifso,explain.N/A,non-projectaction.TheCedarRiverispopulatedbysalmonandincludesspawninggrounds.TherearealsoothercreeksandriverswithintheCitythatcontainsalmonandincludespawninggrounds.d.Proposedmeasurestopreserveorenhancewildlife,ifany:N/A,non-projectaction.6.ENERGYANDNATURAl.RESOURCESa.Whatkindsofenergy(electric,naturalgas,oil,woodstove,solar)willbeusedtomeetthecompletedproject’senergyneeds?Describewhetheritwillbeusedforheating,manufacturing,etc.N/A,non-projectaction.b.Wouldyourprojectaffectthepotentialuseofsolarenergybyadjacentproperties?Ifso,generallydescribe.N/A,non-projectaction.c.Whatkindsofenergyconservationfeaturesareincludedintheplansofthisproposal?Listotherproposedmeasurestoreduceorcontrolenergyimpacts,ifany:N/A,non-projectaction.7.ENVIRONMENTALHEALTHa.Arethereanyenvironmentalhealthhazards,includingexposuretotoxicchemicals,riskoffireandexplosion,spill,orhazardouswastethatcouldoccurasaresultofthisproposal?Ifso,describe.N/A,non-projectaction.1)Describespecialemergencyservicesthatmightberequired.N/A,non-projectaction.2)Proposedmeasurestoreduceorcontrolenvironmentalhealthhazards,ifany:N/A,non-projectaction.b.Noise1)Whattypesofnoiseexistintheareawhichmayaffectyourproject(forexample:traffic,equipment,operation,other)?N/A,non-projectaction.2)Whattypesandlevelsofnoisewouldbecreatedbyorassociatedwiththeprojectonashort-termoralong-termbasis(forexample:traffic,construction,operation,other)?Indicatewhathoursnoisewouldcomefromthesite.N/A,non-projectaction.3)Proposedmeasurestoreduceorcontrolnoiseimpacts,ifany:N/A,non-projectaction.8.LANDANDSHOREUNEUSE-6- a.Whatisthecurrentuseofthesiteandadjacentproperties?N/A,non-projectaction.b.Hasthesitebeenusedforagriculture?Ifso,describe.N/A,non-projectaction.c.Describeanystructuresonthesite.N/A,non-projectaction.d.Willanystructuresbedemolished?Ifso,what?N/A,non-projectaction.e.Whatisthecurrentzoningclassificationofthesite?N/A,non-projectaction.f.Whatisthecurrentcomprehensiveplandesignationofthesite?N/A,non-projectaction.g.Ifapplicable,whatisthecurrentshorelinemasterprogramdesignationofthesite?N/A,non-projectaction.h.Hasanypartofthesitebeenclassifiedasan“environmentallysensitive”area?Ifso,specify.N/A,non-projectaction.Approximatelyhowmanypeoplewouldresideorworkinthecompletedproject?N/A,non-projectaction.j.Approximatelyhowmanypeoplewouldthecompletedprojectdisplace?N/A,non-projectaction.k.Proposedmeasurestoavoidorreducedisplacementimpacts,ifany:N/A,non-projectaction.Proposedmeasurestoensuretheproposaliscompatiblewithexistingandprojectedlandusesandplans,ifany:N/A,non-projectaction.Ifappropriate,projectspecificcompatibilitywithexistingandprojectedlandusesandplanswillbeaddressedandmitigated.9.HOUSINGa.Approximatelyhowmanyunitswouldbeprovided,ifany?Indicatewhetherhigh,middle,orlow-incomehousing.N/A,non-projectaction.b.Approximatelyhowmanyunits,ifany,wouldbeeliminated?Indicatewhetherhigh,middle,orlow-incomehousing.N/A,non-projectaction.c.Proposedmeasurestoreduceorcontrolhousingimpacts,ifany:N/A,non-projectaction.10.AESTHETICSa.Whatisthetallestheightofanyproposedstructure(s),notincludingantennas;whatistheprincipalexteriorbuildingmaterial(s)proposed.N/A,non-projectaction.b.Whatviewsintheimmediatevicinitywouldbealteredorobstructed?N/A,nonprojectaction.c.Proposedmeasurestoreduceorcontrolaestheticimpacts,ifany:N/A,nonprojectaction.-7- 11.LIGHTANDGLAREa.Whattypeoflightorglarewilltheproposalproduce?Whattimeofdaywoulditmainlyoccur?N/A,non-projectaction.b.Couldlightorglarefromthefinishedprojectbeasafetyhazardorinterferewithviews?N/A,non-projectaction.c.Whatexistingoff-sitesourcesoflightorglaremayaffectyourproposal?N/A,non-projectaction.d.Proposedmeasurestoreduceorcontrollightandglareimpacts,ifany:N/A,non-projectaction.12.RECREATIONa.Whatdesignatedandinformalrecreationalopportunitiesareintheimmediatevicinity?N/A,non-projectaction.b.Wouldtheproposedprojectdisplaceanyexistingrecreationaluses?Ifso,describe.N/A,non-projectaction.c.Proposedmeasurestoreduceorcontrolimpactsonrecreation,includingrecreationopportunitiestobeprovidedbytheprojectorapplicant,ifany:N/A,non-projectaction.13.HISTORICANDCULTURALPRESERVATIONa.Arethereanyplacesorobjectslistedon,orproposedfor,nationalstate,orlocalpreservationregistersknowntobeonornexttothesite?Ifso,generallydescribe.N/A,non-projectaction.b.Generallydescribeanylandmarksorevidenceofhistoric,archaeological,scientific,orculturalimportanceknowntobeonornexttothesite.N/A,non-projectaction.c.Proposedmeasurestoreduceorcontrolimpacts,ifany:N/A,non-projectaction.14.TRANSPORTATIONa.Identifypublicstreetsandhighwaysservingthesite,anddescribeproposedaccesstotheexistingstreetsystem.Showonsiteplans,ifany.N/A,non-projectaction.b.Issitecurrentlyservedbypublictransit?Ifnot,whatistheapproximatedistancetothenearesttransitstop?N/A,non-projectaction.c.Howmanyparkingspaceswouldthecompletedprojecthave?Howmanywouldtheprojecteliminate?N/A,non-projectaction.d.Willtheproposalrequireanynewtoadsorstreets,orimprovementstoexistingroadsorstreets,notincludingdriveways?Ifso,generallydescribe(indicatewhetherpublicorprivate?N/A,non-projectaction.e.Willtheprojectuseforoccurintheimmediatevicinityof)water,rail,orairtransportation?Ifso,generallydescribe.N/A,non-projectaction.-8- 1.Howmanyvehiculartripsperdaywouldbegeneratedbythecompletedproject?Ifknown,indicatewhenpeakvolumeswouldoccur.N/A,non-projectaction.g.Proposedmeasurestoreduceorcontroltransportationimpacts,ifany:N/A,non-projectaction.15.PUBLICSERVICESa.Wouldtheprojectresultinanincreasedneedforpublicservices(forexample:fireprotection,policeprotection,healthcare,schools,other)?Ifso,generallydescribe.N/A,non-projectaction.b.Proposedmeasurestoreduceorcontroldirectimpactsonpublicservices,ifany.N/A,non-projectaction.16.UTILITIESa.Iaeatthesitetilcity,naturalgas,water,refub.Describetheutilitiesthatareproposedfortheproject,theutilityprovidingtheservice,andthegeneralconstructionactivitiesonthesiteorintheimmediatevicinitywhichmightbeneeded.N/A,non-projectaction.C.SIGNATUREI,theundersigned,declareunderpenaltyofperjuryunderthelawsoftheStateofWashingtonthattothebestofmyknowledgetheaboveinformationistrue,correct,andcomplete.Itisunderstoodthattheleadagencymaywithdrawanydeclarationofnonsignificancethatitmightissueinrelianceuponthischecklistshouldtherebeanywillfulmisrepresentationorwillfullackoffulldisclosureonmypart.ProponentSignature:NamePrinted:“Lkip’VihI.4ilDate:-9- D.SUPPL.EMENTALSHEETSFORNON-PROJECTACTIONS(Thesesheetsshouldonlybeusedforactionsinvolvingdecisionsonpolicies,plansandprograms.Youdonotneedtofilloutthesesheetsforprojectactions.)Becausethesequestionsareverygeneral,itmaybehelpfultoreadtheminconjunctionwiththelistoftheelementsoftheenvironment.Whenansweringthesequestions,beawareoftheextenttheproposalorthetypesofactivitieslikelytoresultfromtheproposal,wouldaffecttheitematagreaterintensityoratafasterratethaniftheproposalwerenotimplemented.Respondbrieflyandingeneralterms.1.Howwouldtheproposalbelikelytoincreasedischargetowater;emissionstoair;production,storage,orreleaseoftoxicorhazardoussubstances;orproductionofnoise?Theproposedregulationsandamendmentswilllikelynotincrease,release,produce,orfacilitatethestorageofhazardoussubstances,noise,anddischargesoremissionsintowaterorair.Proposedmeasurestoavoidorreducesuchincreasesare:Mitigationwillbedeterminedatthetimeofaproject-specificproposal.2.Howwouldtheproposalbelikelytoaffectplants,animals,fish,ormarinelife?Theproposedregulationsandamendmentsarenotlikelytoadverselyaffectplants,animals,fish,ormarinelife.Proposedmeasurestoprotectorconserveplants,animals,fish,ormarinelifeare:N/Afortheproposal.Mitigationwouldbedeterminedatthetimeofaproject-specificproposal.3.Howwouldtheproposalbelikelytodepleteenergyornaturalresources?Theproposedregulationsandamendmentsarenotlikelytodepleteenergyornaturalresources.Proposedmeasurestoprotectorconserveenergyandnaturalresourcesare:Mitigationwouldbedeterminedatthetimeofaspecificprojectproposal.4.Howwouldtheproposalbelikelytouseoraffectenvironmentallysensitiveareasorareasdesignated(oreligibleorunderstudy)forgovernmentalprotection;suchasparks,wilderness,wildandscenicrivers,threatenedorendangeredspecieshabitat,historicorculturalsites,wetlands,floodplains,orprimefarmlands?Theproposedregulationsandamendmentsarenotlikelytohaveadetrimentaleffectonenvironmentallysensitiveareasorareasdesignatedforgovernmentalprotection.Proposedmeasurestoprotectsuchresourcesortoavoidorreduceimpactsare:Mitigationwouldbedeterminedatthetimeofaspecificprojectproposal.5.Howwouldtheproposalbelikelytoaffectlandandshorelineuse,includingwhetheritwouldalloworencouragelandorshorelineusesincompatiblewithexistingplans?-10- Theproposedregulationsandamendmentsarenotlikelytohaveaneffectonshorelineuse.Anyeffectsonlandusewillbecompatiblewithexistingplans.Proposedmeasurestoavoidorreduceshorelineandlanduseimpactsare:Mitigationwouldbedeterminedatthetimeofaspecificprojectproposal.6.Howwouldtheproposalbelikelytoincreasedemandsontransportationorpublicservicesandutilities?Theproposedregulationsandamendmentsarenotlikelytohavesignificanteffectondemandfortransportationorpublicservicesandutilities.Proposedmeasurestoreduceorrespondtosuchdemand(s)are:Mitigationwouldbedeterminedatthetimeofaspecificprojectproposal.7.Identify,ifpossible,whethertheproposalmayconflictwithlocal,state,orfederallawsorrequirementsfortheprotectionoftheenvironment.Noconflictshavebeenidentified.SIGNATUREI,theundersigned,declareunderpenaltyofperjuryunderthelawsoftheStateofWashingtonthattothebestofmyknowledgetheaboveinformationistrue,correct,andcomplete.Itisunderstoodthattheleadagencymaywithdrawanydeclarationofnon-significancethatitmightissueinrelianceuponthischecklistshouldtherebeanywillfulmisrepresentationorwillfullackoffulldisclosureonmypart.—l---STI-‘120U1ProponentSignature:NamePrinted:Date:-11-