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JD Cont'd from pg 2 . 13 l Application Evaluation Review Sheet Applicant Name : Appl . #300 : Custom Herbicide Applicators, Inc. Address . 15901 Orange Ave , Ft . Pierce , FL 34945 Tract Number(s) : Field Number(s) : 1AII in Indian River County Date : INov . 7 , 2003 V1. Review Summa Land Use/Field : Acres : Citrus Groves 3657 Best Management Practices Applied For: 3. Precision Application Equipment (4 pieces of equipment) . Total BMP Costs : 29.24% Cost Share: Div by Total Eval Points : Div by Acres, times 100 = Applicant Score Applicant Cost: $83 , 332 . 00 $24 , 370 80 8 . 33 1958 , 963 Vil. Remarks : Vill. Designated Conservationist: All AII' / Z o kQ 20/0 /Z9 (Signature) Date: (Checked By) Date: I WCD Board Approval Date B ` O ' O (Applicant Signature) IDate 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 . 590a-f (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 fumished 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 )