5700-54-2 Additional Key Contacts

General Administrative Requirements for Assistance Programs (Renewal)

0938.21 Form 5700-542-sec-0

General Administrative Requirements for Assistance Programs: State, Local, Tribal Governments

OMB: 2030-0020

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Form Approved OMB No: 2030-0020 Approval Expires 06/30/2017

ADDITIONAL KEY CONTACTS
(Use as many sheets as needed.)

Major Co-Investigators: Individual responsible for the completion of major portions of the proposed
work.
Name: _____________________________________________________________________________
Title: ______________________________________________________________________________
Mailing Address: ____________________________________________________________________
___________________________________________________________________________________
Phone Number: ______________________________________________________________________
FAX Number: _______________________________________________________________________
E-Mail Address: _____________________________________________________________________
Web URL: __________________________________________________________________________

Major Co-Investigators: Individual responsible for the completion of major portions of the proposed
work.
Name: _____________________________________________________________________________
Title: ______________________________________________________________________________
Mailing Address: ____________________________________________________________________
___________________________________________________________________________________
Phone Number: ______________________________________________________________________
FAX Number: _______________________________________________________________________
E-Mail Address: _____________________________________________________________________
Web URL: __________________________________________________________________________

Major Co-Investigators: Individual responsible for the completion of major portions of the proposed
work.
Name: _____________________________________________________________________________
Title: ______________________________________________________________________________
Mailing Address: ____________________________________________________________________
___________________________________________________________________________________
Phone Number: ______________________________________________________________________
FAX Number: _______________________________________________________________________
E-Mail Address: _____________________________________________________________________
Web URL: __________________________________________________________________________

EPA Form 5700-54 (Rev 06/2014)


File Typeapplication/pdf
File TitleMicrosoft Word - 5700-542.doc
Authorgcornwel
File Modified2014-07-09
File Created2009-05-14

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