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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: . 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: Ma [ 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: iW [| LAFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Uy shine A ose Vy Et SI ers Date: / | |7 2A Signature: PRINT FORM Page 3 of 3