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5 . Will the project: <br /> a . generate objectional odors : 1,'o <br /> b. generate any discharge into surface waters : NO <br /> C . generate or store hazardous materials : Io <br /> d. expose people to any hazardous materials or situations : ..o <br /> e . displace people: '.o <br /> f . use significant amounts of energy or natural resources : i:o <br /> g . cause congestion on roadways or at interchanges or intersec- <br /> tions: ' o <br /> O 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 /> LJ Owner ' s legal agent (attach proof of the owner ' s consent to file <br /> the application ) , <br /> and that the f regoing i . true and correct . <br /> op(Signature ) Date ) ' <br /> Minor Subdivision - 10 - ( 6/86 ) <br />