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5 . Will the project : <br /> a . generate objectional odors : <br /> b. generate any discharge into surface waters : Q <br /> C . generate or store hazardous materials : ,, <br /> d. expose people to any ha dous materials or situations: � <br /> e . displace people : <br /> f . use significant amounts of energy or natural resources : 5 <br /> g . cause conges i n 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 /> LI 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 /> (Signature ) (Date ) <br /> Minor Subdivision - 10 - ( 6/86 ) <br />