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f <br /> Cont'd from pg 2 . <br /> Application Evaluation Review Sheet <br /> Applicant Name : lCitrus from Indian River <br /> Address : P . O . Box 1266 Vero Beach , FI . 32961 <br /> Tract Number(s): <br /> Field Number(s) . 1 <br /> Date : Nov . 16 , 2002 <br /> VI. . <br /> �tgvtew Sdrf1M <br /> Land Use/Field : Acres . <br /> Micro-Irrigated Citrus Grove N/A <br /> Best Management Practices Applied For: <br /> 4. Portable Agrichemical Mixing Station . <br /> Total BMP Costs : 60% Cost Share: Div By Total Eval Points: = Applicant's Score: Applicant Cost <br /> $ 10 , 600 . $6 , 360 20 318 . 00 $4 , 240 . LIV <br /> Vl1. :Rerrtalrks : <br /> Vill. 'jDeghjfiated .Cong ` ationistj� ,. <br /> d ti►'✓ Ale Z <br /> rz (Signature) Date: (Checked By) ate: <br /> 4F 601 . - 303 <br /> IRSWCD Board Approval Date <br /> 03 <br /> (Applicant Signature) Date <br /> Privacy Act Statement: The following statements are made in accordance with the Privacy Act of 1974 (5U .S .C . 522a) . <br /> The authorities for requesting the information to be applied on this form are: 16 U .S .C . 590a-f (Soil and Water Conversation) ; <br /> 16U .S .C . 3801 et seq . (Food Security Acto of 1985 , as ammended) , and the regulation promulgated theruder. The information <br /> requested is necessary for the evaluation of an application , development and implementation of a conservation plan as the <br /> basis for satisfying program eligibility and compliance requirements , and for providing technical education , or financial assist- <br /> ance under the previously mentioned authorities. Furnishing this information is voluntary; however, failure to furnish correct, <br /> complete information will result in the withholding or withdrawal of such technical, educational, or financial assistance. This <br /> information may be furnished to other USDA agencies , the Internal Revenue Service, the Department of Justice, or the other <br /> State or Federal law enforcement agencies , or in response to orders of a court, magistrate, or administrative tribunal . <br /> IRSWCD <br /> Page 3 ( 10-26-01 ) <br />