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Cont'd from pg 2 . Application Evaluation Review Sheet Applicant Name : TApp # 24 , 25 . IMG Citrus. Address : 17836 Cherry Lake Rd . Groveland , FI . 34736 Tract Number(s) : Field Number(s) : All in I . R . County Date : INov . 16 , 2002 VL; Review -Summ Land Use/Field : Acres : Micro-Irrigated Citrus Grove 380 Best Management Practices Applied For. 4. Portable Agrichemical Mixing Station . Total BMP Costs : / 60% Cost Share : Div By Total Eval Points: = Applicant's Score: Applicant Cos $ 1 , 522 . $913 20 45 . 66 $60gj Vil . fterita*s: VIII. Designated f.6riservationist. 57 1 14� x 4 lei 2�� (Signature) I Date (Checked By) Date: 4 - 1 - O IRSWCD Board Approval Date IL 23 - 03 (Applicant Signature) Date 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 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 )