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Florida Department of Environmental Protection Bob Martinez Center 2600 Blair Stone Road Tallahassee, FL 32399-2400 Charlie Crist, Governor Jeff Kottkamp, Lt. Governor Michael W. Sole, Secretary |
INSTRUCTIONS: Complete the form, print it, sign it and return it to: DEP, Solid Waste Section Mail Station # 4565, 2600 Blair Stone Rd, Tallahassee, Florida 32399-2400. (This application is due by July 1 of each year.)
CONSOLIDATED SMALL COUNTY SOLID WASTE MANAGEMENT GRANT APPLICATION
County Name:
Address:
FEIN:
Population:
Address:
FEIN:
Population:
Contact Person
(person handling program on a daily basis):
Name:
Title:
Address:
Phone:
Email:
(person handling program on a daily basis):
Name:
Title:
Address:
Phone:
Email:
Authorized Representative:
Name:
Phone:
Email:
Name:
Phone:
Email:
I CERTIFY that I am familiar with the information contained in this application, and that to the best of my knowledge and belief such information is true, complete and accurate. I further certify that I possess the authority to apply for this grant on behalf of this county.
_____________________________________________ Signature of Authorized Representative |
_______________________ Title |
_______________ Date |