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5 . Will the project: <br /> a . generate objectional odors : /J i9- <br /> b. generate any discharge into surface waters : <br /> C . generate or store hazardous materials : <br /> d. expose people to any ha ardous materials Ar situations: <br /> e . displace people: <br /> f . use significant amounts of energy or natural resources : <br /> g . cause con on on roadways or at interchanges or inters c- <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 /> —"` Owner ' s legal agent (attach proof of the owner 's consent to file <br /> the application) , <br /> and th t t e foreg in is true and correct . <br /> ►Y <br /> (Signature ) (Dat6 ) <br /> Minor Subdivision - 10 - ( 6/86 ) <br />