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5 . Will the project: <br /> a . generate objectional odors : /U Q <br /> b. generate any discharge into surface waters : Nv <br /> C . generate or store hazardous materials : A/C <br /> d. expose people to any hazardous materials or situations :�o <br /> e . displace people: /)p <br /> f . use significant amounts of energy or natural resources : ,$/O <br /> g. cause congestion on roadways or at interchanges or intersec- <br /> tions: _1Vp <br /> ❑ SIGNATURE <br /> Z certify under penalty of perjury that Z 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 foregoing is true and correct. <br /> 7/�- 6 <br /> (Signa ure ) (D te ) <br /> Minor Subdivision - 10 - ( 6/86 ) <br />