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5 . Will the project: <br /> a . generate objectional odors : 00 <br /> b. generate any discharge into surface waters : �40 <br /> C . generate or store hazardous materials : Nd <br /> d. expose people to any hazardous materials or situations : <br /> e . displace people : 1_4D <br /> f . use significant amounts of energy or natural resources :N_ <br /> g . cause congestion on roadways or at interchanges or intersec- <br /> tions : Wo <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 /> LJOwner ' s legal agent (attach proof of the owner ' s consent to file <br /> the application ) , <br /> an hat the foregoing is true and correct . <br /> ignature ) ,: (Date ) <br /> M hy - Ir 1186 <br /> MRY <br /> Minor Subdivision T 10 - ( 6/86 ) <br />