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14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: [Shoreline [_] Forest [_] Agricultural/grasslands [] Early mid-successional [-]Wetland [_] Urban [¥] Suburban 15. Does the site of the proposed action contain any species of animal, or associated habitats, listed by the State or esl Bi: Nn Federal government as threatened or endangered? N 2 NININ|4]é) 16. Is the project site located in the 100-year flood plan? E re [ Nn 17. Will the proposed action create storm water discharge, either from point or non-point sources? ES < If Yes, KHOU a. Will storm water discharges flow to adjacent properties? b. Will storm water discharges be directed to established conveyance systems (runoff and storm drains)? If Yes, briefly describe: 18. Does the proposed action include construction or other activities that would result in the impoundment of water NO | YES or other liquids (e.g., retention pond, waste lagoon, dam)? If Yes, explain the purpose and size of the impoundment: a 19. Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste NO | YES management facility? If Yes, describe: oH 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: L_ I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE | Applicant/spon Cz C Pac CB dauc) Date: Yau 2OLG Signature: 7 y Title: Serer SS PRINT FORM Page 3 of 3