Schedule A (REVISED) - Florida

What Is Schedule A (REVISED)?

This is a legal form that was released by the Florida Department of Environmental Protection - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the Florida Department of Environmental Protection;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Schedule A (REVISED) by clicking the link below or browse more documents and templates provided by the Florida Department of Environmental Protection.

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Download Schedule A (REVISED) - Florida

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Mail duplicate original to:
Solid Waste Financial Coordinator
Florida Department of Environmental Protection
2600 Blairstone Road MS 4548
Tallahassee, Florida 32399-2400
SCHEDULE A (Revised)
To be attached to State of Florida Solid Waste Facility
Agreement entered into
Enter “Trust Fund” or “Standby Trust Fund”
as of
by and between
,
Date of Agreement
Owner or operator
the Grantor, and
, the Trustee,
Bank name
for account number
Enter “N/A” if pooled account or no acct. no. assigned
This Agreement is amended to demonstrate financial assurance for cost estimate(s) on file with FDEP for the
following facility(ies)*.
Facility Cost
FDEP I.D.
Estimate**
(total of
Number
Facility Name
Site Address
Required Action amounts)
This amendment is executed on
and will become effective upon FDEP approval.
GRANTOR
TRUSTEE
Authorized Signature for Grantor
Delegation of Authority
Authorized Signature for Trustee
Type Name and Title
Type Name and Title
Telephone Number
Telephone Number
E-mail Address
E-mail Address
Signature of Witness or Notary
Date
Printed Name of Witness or Notary Seal
__________
*
- Removal of a facility from a standby trust fund or trust fund agreement, in accordance with FDEP regulations, requires prior written
permission from the FDEP Tallahassee Office. Authorization will be addressed to the Trustee and will specify agreement by date.
**
- For each facility, enter the most recent Department approved facility cost estimate amount, or subsequently increased amount.
SAVE
PRINT
CLEAR
Mail duplicate original to:
Solid Waste Financial Coordinator
Florida Department of Environmental Protection
2600 Blairstone Road MS 4548
Tallahassee, Florida 32399-2400
SCHEDULE A (Revised)
To be attached to State of Florida Solid Waste Facility
Agreement entered into
Enter “Trust Fund” or “Standby Trust Fund”
as of
by and between
,
Date of Agreement
Owner or operator
the Grantor, and
, the Trustee,
Bank name
for account number
Enter “N/A” if pooled account or no acct. no. assigned
This Agreement is amended to demonstrate financial assurance for cost estimate(s) on file with FDEP for the
following facility(ies)*.
Facility Cost
FDEP I.D.
Estimate**
(total of
Number
Facility Name
Site Address
Required Action amounts)
This amendment is executed on
and will become effective upon FDEP approval.
GRANTOR
TRUSTEE
Authorized Signature for Grantor
Delegation of Authority
Authorized Signature for Trustee
Type Name and Title
Type Name and Title
Telephone Number
Telephone Number
E-mail Address
E-mail Address
Signature of Witness or Notary
Date
Printed Name of Witness or Notary Seal
__________
*
- Removal of a facility from a standby trust fund or trust fund agreement, in accordance with FDEP regulations, requires prior written
permission from the FDEP Tallahassee Office. Authorization will be addressed to the Trustee and will specify agreement by date.
**
- For each facility, enter the most recent Department approved facility cost estimate amount, or subsequently increased amount.