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2007/2008 Used Oil Recycling Block Grant Application (13th Cycle) Attachment 2 Application Due Date: Postmarked on or before June I, 2007; tsi~i>iiii' Hand-delivered applications received by 3:00 p.m. on or before June I, 2007 pplicant: (If a regional program, list lead agency first and add/cross out jurisdictions that huge changed status) City of Pleasanton Estimated Total Grant Amount: $ ~ Address: New Address: tu•changcd) 3560 Nevada Street ' Pleasanton. CA 94566 Primary Contact: Danielle Stefani New Primary Contact: tlfchanged) Printed Name of Primary Contact Title: Hazardous Materials Coordinator Printed Name of Primary Contact Title: Phone: 925--t54-2338 Phone: E-Mail address: dstefani@Ipfire.urg E-Mail address: Fax: 925-454-2367 Fax: Signature Authority(as designated in Resolution): Nelson Fialho ew Si ore Authority: (If changed) Printed Name of Signature Authority Title: City Manager Printed Name of Signature Authority Title: Phone: 925-931-5(102 Phone: -Mail address: E-Mail address: Fax: 925-93 I -5482 Fax: State Senate Dist: 10 State Assem bl Dist: 11 Count :Alameda COnSUltant: (If applicable) New Consultant: (If applicable and/or changed) Contact Name: Contact Name: Phone: Phone: E-titail address: E-ivfail address: Fax: Fax: Advance Payment Option: Fur (irantccs recci~ ing gZt-.t)Ill- ur Icss, and multi- jurisdirtiunal :utd regional ~~r:rmrc, whu,c indi~idual.juri,dirtiuns wunlJ ha~c rrcci~cJ .SZ(1.0(M) ur Elea ad~•an~e payment option Ic,s had they applied indi~ ideally - .Id~anrc payment Iti a~allUhlc. Certification dc~ lace, under p ally uF perjur hat all inti~rmation ,uhrnitted tier the Caliti~rnia Integrated V4'aste !~tanagemcnt Board's con,iderati~l t<~r loca ' ~~ ut' ~ a funds is true and accurate to thr hest of my acknu~tiledge ;utd helief. ~52s D~-' 1uth~~riird tiiznat~lry Title _ I~atr ~1ail fu: C'alitl~rnia Int~~~ratrd ~~'a,tr ~lanag~ntrnl R~~ard. ,lurntilln: (Trutt, .\dmini,natilln l'nil tit~lll: 13G I I'~h (•y~lr~ tier t~Y 'llll(i~?IN17: I(IUI I Sh'cCt. I'.O. 13ut -111?5, ~;I~r;lntunt~~. (~;~ ~)i!{I? ~}II?l