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CI <br />00-17.3 <br />�.;1� tgpi?fti;4 w rum as -ere ocanr <br />'Department of <br />FLOR A., . Environmental Protection <br />Twin Towers Office Building <br />Jeb Bush 2600 Blair Stone !toad David B. Struhs <br />Governor Tallahassee. Florida 32399-2400 Secretary <br />Solid Waste Recycling and Education Grant Application <br />Part One <br />1. Name of Applioariv TNDIJAN RIVER 07UNTY <br />2. Address of Applicant: 1 840 25th SI'REEP <br />Q REACH, TM 12960 <br />3. Federal Employer Identification Number: 59-6000674 <br />4- Telephone Number of Applicant: 1561 1 770-5113 <br />5. List of Counties and Municipalities Included in the Application: <br />1Y�r7N [7F TMAAi R f T I Y fFh <br />r 'TOM f7E OR 'ITD <br />6. Contact Person (person handling program on daily hasisl: <br />7. Add2o7Cotac1139thVELVt11" <br />S.W. <br />1MR0 EEAQ4, FL 32968 <br />S, Tolephono Number of Contact Parson: 1 561 I 770-5113 <br />9. Noma and Title of Authorized Representative: <br />Name: FBAN B_ ADAMS <br />Title:b4— Ai> AC <br />10. Required Attachments (Due July 1 of each yearl: <br />__X__A copy of any interlocal agreement entered into botwoen local governments to accomplish the purposes of <br />Shia rule. Rule 62.716.410[llf <br />11, EMAIL ADDRESS: <br />I CERTIFY that 1 am familiar with the information containod in this appleeation, and that to the host of my knowledge and <br />belief such information is true, complete and accurate. I further certily that I possess the authority to apply for this grant on <br />ho half of this local government. <br />�I L 1i. 6 ( ,,rr ic-6'1 <br />Pulte 6. 2000 <br />Signature of Authorized Representative <br />Date <br />FRAN 3. eT,L7A14.Sr CHALK WI <br />ODUY COMISSI0"Mer Plt form t <br />F30ARD orNT <br />of Environmental <br />eparlrnanof Envirvnantal Prelectiun <br />Bureau of Solid and Haiardous Waste <br />- - - - <br />Solid Waste Soction ` Mail Station N 4565 <br />-.. <br />J j oa <br />2600 ®lair Stone Road <br />Tallahassee, Florida 32399.2400 <br />Page 1 of 1 5100 <br />"Protect Conserve and Manage Florida's Environment and Natural Resources" <br />Panted on 1"led paper. <br />