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e4 " PLAN MAP AMENDMENT <br /> N: <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: - <br /> Razardous Materials <br /> Describe any hazardous materials/wastes that will be present on-site: <br /> Products associated with trucking and general maintenance. <br /> Other <br /> Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): <br /> N/A <br /> Describe any on-site or off-site sources of noise or vibration(e.g.freeway noise,heavy equipment,etc.): <br /> Highway 99 related noise. Truck circulation on site. <br /> nil <br /> site or off-site sources of light of glare (e.g.parking lot lighting,or reflective materials used): <br /> cars on Hi hwa C99. Pn site securitylight. <br /> site or off-site source of odor(e.g.agricultural wastes): <br /> placement of people that will be caused by the project(e.g.numbers of people,housing units): <br /> AUTHORIZATION'SIGNATURES <br /> 7rOwner/Agent <br /> OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> m, action or proceeding against the County arising from the Owner/Agent's project.rtify under penalty of perjury that I am (check one): <br /> operty owner(owner includes partner, trustee, grantor, or corporate officer)of the property(s) involved inication, 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 fore of licatio ments are true and correct. <br /> ;� / Si <br /> Print Name: I"SiSbfYCD CLtyh't_ nature: Date:9 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: <br /> Si nature: Date: <br /> F:\DEVSVC\Plammng Application Forms\ Page 7 of 7 <br /> Plan Application Amendment.doc.(Revised 05-11-09 <br />