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PLAN MAP AMENDMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> E, <br /> Hazardous`Materials <br /> Describe any hazardous materials/wastes that will be present on-site:: <br /> Diesel fuel and lubricants <br /> Describe any items of historical or archaeological interest on-site.(e.g.cemeteries or structures): <br /> None <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise, heavy equipment,etc.); <br /> Freeway noise <br /> Describe any on-site or off-site sources of light of glare(e.g.parking lot lighting,or reflective materials used): <br /> None <br /> Describe any on-site or off-site source of odor(e., .agricuftural wastes): <br /> None <br /> Describe any displacement of people that will be caused by the project(e.g. numbers of people,hous-ng units): <br /> None <br /> AUTHORIZATION SIGNATURES' <br /> ;ONLY THE OWNER OFTHEP ROPE kTY-OR AN AUTHORIZED AGENT.MAY FILE AWAPPLICATION]'�­!` <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees from <br /> any claim, <br /> m, action or proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> Legal property owner(owner includes partner, trustee, grantor, or corporate officer) of the property(s) involved in this <br /> application, or <br /> Legal agent (attach proof of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to file on their behalf.,and that the re o` applicat'on 4atements are true and correct. <br /> Print Name: 0"V C 51 Signature: Date:_ /66 9_9 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> ILPrint Name: Signature: <br /> Date: <br /> FADEVSMPlanning Application Forms\ Page 8 of 8 <br /> General Plan Amendmentdoc.(Revised 3-5-04) <br />