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<br /> Describe air pollutants that may result from the project(e.g.,construction related dust,vehicle trips per day,fireplaces,incinerators,etc.):
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<br /> Describe any hazardous matenals/wastes that will be present on-site:
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<br /> Describe any itemr ofhistorical or archaeological interest on-site(e.g.,cemeteries or structures):
<br /> Describe any on-site of off-site sources ofnoise or vibration(e.g.,freeway noise,heavy equipment,etc.):
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<br /> Describe any
<br /> /on-site or off-site sources of light or glare(e.g.,parking lot lighting,or reflective materials used):
<br /> Describe any on-site or off-site source of odor(e.g.,agricultural wastes):
<br /> Describe any displacement of people that will be caused by the project(e.g,,numbers of people,housing units):
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<br /> SIGNATURE: I certli�under penalty of perjury that I am(check one):
<br /> o Legal property owner(owner includes partner,trustee,trustor,or corporate ofcer)of the property(s)involved
<br /> in Utas application,or
<br /> -2-
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