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� . Will the project : / <br /> a . generate objectional odors : <br /> b. generate any discharge into surface waters : <br /> c . generate or store hazardous materials: <br /> d. expose people to any hazardous materials or situations: <br /> e . displace people: <br /> f. use significant amounts of energy or natural resources : <br /> g. cause congestion on roadways or at interchanges or intersec- <br /> tions: <br /> ❑ SIGNATURE <br /> I certify under penalty of perjury that I am (check one ) : <br /> Legal Property Owner (owner includes partner, trustee, trustor, or <br /> corporate officer . ) <br /> Owner ' s legal agent (attach proof of the owner ' s consent to file <br /> the application ) , <br /> and that the r is true and correct. <br /> 4�ZZIIL_12 <br /> (Signa (Date ) <br /> Minor Subdivision - 10 - ( 6/86 ) <br />