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FLORI A ' 1 <br />'eb Bush <br />Governor <br />1. Nome of <br />bb , <br />Department of <br />c71Mhn _� <br />Environmental Proti cdion- <br />Twin Towers Office Building <br />2600 Blair Stone Road David Q. Struhs <br />Tallahassee. Florida 32399-2400 Secretary <br />Solid Waste Recycling and Education Grant Application <br />Part One <br />.11 _ i e ■,reit 09 6' Yl <br />2. Address of Applicant: 1 840 25th 9M= <br />VENO BTA F 32960 <br />3. Federal Employer identification Number:, <br />59-6000674 <br />4. Telephone Number of Applicant: ( 561 1 770-5113 <br />5, l.laf of Countioa end Municipaliliea Included in ilia Application: <br />CITY OF VEI2O BEACH. CITY OF SEBASTIAN, M7N OF INDIAN RIVER SHORTS, <br />nrmy n>n >:*r-r.r crt�a>ti mt,Th1 nF ORCiiTD <br />6. Contact Parson iparson .handling program on daily basis): <br />_RWAT.D R. BurxlxS <br />7. Adclrncs of Contact Person: <br />1325 74t3s AVENUE SW <br />impia Rt+21r'N El 32gA f <br />8. Telephone Number of Contact Parson: l 551 1 770-5113 <br />9. Nemo and Title of Authorized Representative: <br />Name: iCFi H R. MRCHT <br />Title:j j'�TSFMAN., pCmn rip fTt1Tl+?'PV C=ISSTOf'iERS <br />10. Required Attachments (Due July I of each year]: <br />XA copy of any interlocal agreement entered into between local governments to accomplish the purposes of <br />this rule. Rule fit -716,410[8 <br />i CERTIFY that t am familiar wish the information contained in thla application, and that to the heat of my knowledge and <br />belief such information Is true, complete and accurate. I further certify that I possess the authority to apply for this grant on <br />bahalf of this local government. <br />Si aturo of Authorized Representative Data <br />KENNM R. M afrr C14AIRMAN <br />BOARD OF f77LfN7PY CC]MNIISSIONTFLS Please return form to:14 ev-��4I <br />Deportment of Environmental Protoction // <br />Bureau of Solid and Hazardous Waste <br />Solid Waste Section' Mail 'Station 9 4505 til d <br />2600 61ab 5tana Road <br />Tallahassee, Florida 32399.2400 <br />Page 1 of 1 5199 7f i <br />"Notect Conserve and Mor10g@ Florida's Friyleanmeftf and Natural Resourcirs" <br />Printed on rrgvkd paper. <br />