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2007/2008 Used Oil Recycling Block Grant Application (13t" Cycle) <br />j Application Due Date: Postmarked on or before June I, ?007; <br />'~'~'~'" Hand-delivered a lications received b `i 00 m. on or before June I, ?007 <br />rsruou pp Y .: p. <br />APPircant: (If a regional program. list lead agency first and add/cross out jurisdictions that have changed status) <br />City of Pleasanton <br />Estimated Total Grant ArnounL $ ~ 7 300 <br />Address: <br />35611 Nevada Street <br />Pleasanton, CA 94566 New Address (u~cbaogcd) <br />Primary Contact: Danielle Stefani New Primary Contact: (Ifchangall <br />Printed Name of Primary Contact <br />Title: Hazardous Materials Coordinator Printed Name of Primary Contact <br />Title: <br />Phone: 925-45d-2338 Phone: <br />E-Mail address: dstefaniC~lpfire.org GMail address: <br />Fax: 925-45d-2367 I~ax: <br />Signature Authority(as designated in Resolution): <br />Nelson Fialho New Signature Authority: Uf changaU <br />_ <br /> <br />Printed Name of Signature Authority <br /> <br />Title: City Manager _--_ <br />Printed Name of Signature Authority <br />Fide: <br /> <br />- -- <br />Phone: 925 x)31-5002 Phone: <br />- <br />- <br />L"-Mail address: E-Mail address: <br /> <br />---- <br /> --- <br />Fax:925-931->d82 Fax: <br />State Senate Dist: 10 State Assembl Dist: l l Count :Alameda <br />Consultant: (II'applicahlc) New Consultant: (Ifappliarhlcand/orchungcd) <br />Contact Name: Contact Name: <br />Phone: Phone: <br />E-Mail address: E-Mail address: <br />Fax Fax: <br />Advance Payment Option: For Grantees receiving 520.000 or Icss. and multi- <br />jurisdictiunal and regional eruntecs whose individual jurisdictions would have received 530.000 of <br />Icss had they applied individually advance payment is available. <br />X Elect advance payment option <br />Certification <br />I declare. under penalty of perjury, that all information submitted for the California Integrated Waste Management Board's <br />consideration for allocation of ~~rant funds is true and accurate to the best of my acknowledge and bclieF. <br />C.itu Manaaeh. <br />Authorized SianaUn' ~ Title llate <br />Mail To: California Integrated Waste Management Board, Attention: Grants Administration Unit MS 10; BG (I2'~' <br />Cycle) for FY 2006/2007: 1001 [Street. P.O. Box -4025, Sacramento. CA 95812--L035 <br />ATTACHMENT A <br />