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How did you learn about the CVA Grant Program? ❑ DEP Workshop ❑ DEP Website ❑ Radio/TV Ad ❑ Another Marina Owner/Operator The facility is a designated: ❑ Clean Marina ❑ Clean Boatyard ❑ Clean Retailer Are you interested in learning more about the Clean Marina Program? 0 Yes Q No How will the facility inform the public that there are pumpout facilities are available for their use? Pumpouts will be provided at: ® No Charge Q $5.00/pumpout Does the facility have a policy in place to address pumpout compliance by the facility tenants? ❑ DEP Staff Pumpout ❑ Vendor ❑ Clean and Resilient ❑ None ❑ Yes ❑ No If fees ($5/pumpout) are collected, they are to be used to defray the costs of operations, maintenance and repairs and should be reported to DEP quarterly. Does the facility have or plan to have a preventative maintenance plan to sustain the pumpout equipment after the installation? OYes Q No Would your facility like a supply of Clean Boating educational materials? ❑ CVA Fact Cards ❑ Clean Boater Habits ❑ Boater Pledge Cards ❑ Stickers ❑ Children/Youth Boater activity (Officer Snook) book Briefly summarize the proposed pumpout project and how grant funds will be used to complete the project: For Example: ABC Marina plans to install one stationary pumpout to service resident and visiting boats. The pumpout will be installed on the dock with 150' piping and 20 connections to service each boat slip. The proposed pumpout equipment will be purchased and installed by contractors. The plumbing and electrical wiring will be installed by local contractors. We plan to purchase and install the signs ourselves utilizing marina staff time. ABC also would like to apply for funds to operate and maintain the equipment once installed. ,_ ------------------------------------------------------------------------------------ , r , , , , , , t 165