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. w ' <br /> 5 . Will the project: <br /> a . generate objectional odors : Al0 <br /> b. generate any discharge into surface waters : A)Q <br /> c . generate or store hazardous materials: A)"I <br /> d. expose people to any hazardous materials or situations :_ <br /> e . displace people: V0 <br /> f . use significant amounts of energy or natural resources : _4�ns <br /> g . cause congestion on roadways or at interchanges or intersec- <br /> tions: 4)Q <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 /> LJ Owner ' s legal agent (attach proof of the owner 's consent to file <br /> the application ) , <br /> and that the foregoing is true and correct . G <br /> r Q <br /> (Signature ) (Date ) <br /> Minor Subdivision - 10 - ( 6/86 ) <br />