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Cont'd from pg 2 . Exh ; blt ' � ' Application Evaluation Review Sheet Applicant Name : Applicant #415 ; Sun Ag , Inc. Address : 17735 County Road 512 , Fellsmere , FL 32948 Tract Number(s) : Field Number(s) : 598913124125 ,29 , 30133 . Date : July 9 , 2004 VI. Re** l �Ima Land Use/Field : Acres : Micro4rrigated Citrus Grove 700 Best Management Practices Applied For: Install 11 BR H2o Control Structure. Total BMP Costs: 75% Cost Share: Div By Total Eval Points: = Applicanrs Score: Applicant Cost: $66 ,666 $507000 275 181 .82 $ 16 ,667 vita Rq"IO VIIL DeSignaUdIrlr : aAh 7 (Signature) e: (Checked By) Date: IRSWCD rd Approval Date (Applicant Signature) Efate Privacy Act Statement: The following statements are made in accordance with the Privacy Act of 1974 (5U . S .C . 522a) . The authorities for requesting the information to be applied on this form are: 16 U . S .C . 590a4 (Soil and Water Conversation); 16U . S . C . 3801 et seq. (Food Security Acto of 1985, as ammended), and the regulation promulgated theruder. The information requested is necessary for the evaluation of an application, development and implementation of a conservation plan as the basis for satisfying program eligibility and compliance requirements, and for providing technical education , or financial assist- ance under the previously mentioned authorities. Furnishing this information is voluntary; however, failure to furnish correct, complete information will result in the withholding or withdrawal of such technical, educational, or financial assistance. This information may be furnished to other USDA agencies, the Internal Revenue Service, the Department of Justice, or the other State or Federal law enforcement agencies, or in response to orders of a court, magistrate, or administrative tribunal. IRSWCD Page 3 (10-26-01 )