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PLAN Iv-.AP AMENDMENT z SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT FILE NUMBER: -_ - Hazardous Materials Describe any hazardous materials/wastes that will be present on-site:: NONE -- Other Describe any items of historical or archaeological interest on-site(e.g.cemeteries or structures): NONE Describe any on-site or off-site sources of noise or vibration (e.g.freeway noise, heavy equipment,etc.): TELE PROPERTY IS M EDTAT'ELY ADJACENT TO HIGHfXY 99 ON THF, WEST SIDE E+lFDIA=Y ADJACENT TO OFFRAMP Describe any on-site or off-site sources of light of glare(e.g. parking lot lighting,or reflective materials used): ONCE DEVELOPED THERE WILL BE ON-SITE LIGHTING FOR PAR=413 AND LIGHIDIG FOP, EXISTING USES LIMITED TO THE SITE ITSELF Describe any on-site or off-site source of odor(e.g. agricultural wastes): NONE Describe any displacement of people that will be caused by the project(e.g. numbers of people,housing units): NUKE _ AUTHORIZATION SIGNATURES ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. 1, the Owner/Agent agree, to defend, indemnity, and hold harmless the County and its agents, officers and employees from any claim, action or proceeding against the Owner/Agent's project. I, further, certify under penalty of perjury that I am (check one): ❑ Legal property owner (owner includes partner, trustee, grantor, or corporate officer) of the property(s) involved in this application, or Legal agent(attach proof of the owner's consent to the application of the p perty's involved in this application and have been authorized to file on their behalf., and tha"heloogoing pppiicUqnstatements are true and c rrect Print Name: H047ARD L. SEI ICMAN Signatu Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: F:0EVSVC\P1anning Application Forms Page 7 of 7 Plan Apphi tion Amendment.dm (Revised 12-07-06)