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5 . Will the project : <br /> a . generate objectional odors : IVa <br /> b. generate any discharge into surface waters : <br /> C . generate or store hazardous materials : v <br /> d. expose people to any hazardous materials or situations : Vd <br /> e . displace people : Vo <br /> f . use significant amounts of energy or natural resources : <br /> g . cause congestion on roadways or at interchanges or intersec- <br /> tions : <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 /> �--J 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 /> •�G �Ll 8 7 <br /> Si a ) (D te ) <br /> �� G G cQ - <br /> Date <br /> S:'.gnature Date <br /> Minor Subdivision - 10 - ( 6/86 ) <br />