Text · page 15 of 20
Read the whole document on one page (all 20 pages, each with its own heading)
This document was a scan. Its text was produced by character recognition and may contain errors; check the original for exact wording.
18. Does the proposed action include construction or other activities that result in the impoundment of NO | YES
water or other liquids (e.g. retention pond, waste lagoon, dam)?
If Yes, explain purpose and size:
Wil
19. Has the site of the proposed action or an adjoining property been the location of an active or closed NO | YES
|
solid waste management facility?
= |_|
If Yes, describe:
ure — mw : "8 “aT
? Oo. ey ” Y ad uy
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?
If Yes, describe:
' | |
oneness
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE
Applicant/sponsor name: Robert N Hopkins
Date: if / { si 2OKG
Signature: Pose vii Td op A~
PRINT FORM Page 3 of 3