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18, Does the proposed action include construction or other activities that result in the impoundment of NO | YES waiter or other liquids (e.g, retention pond, waste lagoon, dam)? If Yes, explain purpose and size: = 19, Has the site of the proposed action or an adjoining property been the location of an active or closed NO | YES 1 solid waste management facility? L] If Yes, describe: ea = i. ais ® md 20. Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing or | NO | YES completed) for hazardous waste? Tf Yes, describe: [| [| AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor Pp name: Robert N Hopkin Date: f / / sf ROR Signature: Fo cxfe. Tn dap A————— PRINT FORM Page 3 of 3