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5 . 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 /> UOwner ' s legal agent (attach proof of the owner 's consent to file <br /> the application) , <br /> and that the foregoing is true and correct. <br /> (Sign ture ) (Date ) <br /> Minor Subdivision - 10 - ( 6/86 ) <br />