Any eligible person applying for a grant under the program shall include the following information in the application:

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(1) The name of the person and the address of the retail motor fuel site to be improved;

(2) A detailed description of the infrastructure to be installed, replaced, or converted, including, but not limited to, the model number of each motor fuel storage tank to be installed, replaced, or converted, if available;

(3) A statement describing how the retail motor fuel site is to be improved, the estimated cost of the planned improvement, and the date when the infrastructure will be first used; and

(4) A statement certifying the infrastructure project complies with section 66-2203 and will comply with a cost-share agreement entered into with the department pursuant to section 66-2205 unless granted a waiver by the department.