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<br /> Describe air pollutsira that may result frorn the pro]ea(e.g.,construction related dust,vehicle trips per day.fireplacm incinerators,da):
<br /> Decnbe any hazardous materiaWwssta that will be present ort-sits: — lUo a t)OJ t J
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<br /> Do=-&a say items of historkat or arshse kWal ustm=t on-site(e g,oemcmm or structurv): /f � "60,)0 ,
<br /> Deeaibe any on-site ora@'-site sources ofnoiee orvibration(e.g,freeway noise,heavy equipmet:,ete.):
<br /> Dambe stay on-site or off-site source of tig)rt or ghare(e.g.,parking lot lighting,or reflective materials used):
<br /> Descrile any onsite or off-site source of odor(e g.,agiculttral waste
<br /> Deac'rr"be any dispiaarareat of people that wilt be caused by the protea(ef,numbom of temple,boring units):
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<br /> SICNA'I'LFItI?: I certifyuupder penalty of perjury that I am(eheckt opt):
<br /> o InW property owner(owner includes partner.trustee,tr ,utar,or corporate omcer)of the property(s)involved
<br /> Lu this application,or
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