14-18 Exhibit-Application for Discharge Site Remediation Funds from HDSRF.pdf

New Jersey Department of Environmental Protection Site Remediation Program HAZARDOUS DISCHARGE SITE REMEDIATION FUND – PART I Date Stamp LSRP Subsurface Evaluator (for UHOT cases only) (For Department use only) SECTION A. REQUESTED FUNDING TYPE AND AMOUNT PLEASE CHECK HERE IF INITIAL APPLICATION HAS BEEN SUBMITTED Public Entity Brownfield Development Area Grant ...........................................$ 375,000.00 PA/SI/RI Grant .............................................................................$ 75% Recreation and Conservation Grant ....................................$ 21,000.00 Block 7, Lot 22 75% Renewable Energy Grant ....................................................$ 50% Affordable Housing Grant ....................................................$ 25% Matching Grant Remedial Action(LR/UR) ...........................$ 25% Matching Grant Innovative Technology ...............................$ Loan .............................................................................................$ Private Entity 50% Innocent Party Grant ...........................................................$ 25% Matching Grant Remedial Action(LR/UR) ...........................$ 25% Matching Grant Innovative Technology ...............................$ Loan .............................................................................................$ Non-Profit PA/SI/RI Grant .............................................................................$ SECTION B. APPLICANT INFORMATION Name: Township of West Orange Address: 66 Main Street City: West Orange State: New Jersey County: Essex Zip Code: 07052 Phone Number: (973) 325-4160 Ext: Fax: Email Address: JSayers@westorange.org Individual: Social Security Number: Businesses:

25-4160 Ext: Fax: Email Address: JSayers@westorange.org Individual: Social Security Number: Businesses: Tax ID Number: SIC: NIAC: SECTION C. CONTACT INFORMATION Check here if contact information is the same as Section B above (proceed to Section D) Contact Person: John K. Sayers Title: Business Administrator Affiliation: Township of West Orange Address: 66 Main Street City/Town: West Orange State: NJ Zip Code: 07052 Phone Number: (973) 325-4160 Ext: Fax: Email Address: JSayers@westorange.org HDSRF Application Part I Page 1 of 4 Version 1.3 12/11/13