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5 . Will the project: <br /> a . generate objectional odors : <br /> b. generate any discharge into surface waters:- <br /> c . generate or store hazardous materials : ,41I <br /> d. expose people to any hazardous material or situations: U <br /> e . displace people: 71 <br /> f . use significant amounts of energy or natural resources : <br /> g. cause congestion . on roadways or ap, ,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 /> uOwner ' 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 /> Jai Gam i ure (Date ) <br /> Minor Subdivision - 10 - (6/86 ) <br />