Washtenaw County Environmental Excellence Partnership Program -
(Community Partners for Clean Streams & Waste Knot)

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* 1. Location

Organization/Company Name: *

Contact Person - Name & Title *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Email Address: *

Phone Number: *

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* 2. Secondary Contact (this can be an actual person or a general email for your organization)

Name & Title:

Email:

Phone Number:

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* 3. How many employees do you have at this location?

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* 4. Website address:

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* 5. Business / Organization Description (what it does and what makes it unique). (e.g. Greenhouse specializing in plants native to MI)

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* 6. How many locations do you have in Washtenaw County?

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* 7. Does your organization have any written policies/statements for:

	Have Already	Would Like
Environmentally preferable purchasing (EPP)	Environmentally preferable purchasing (EPP) Have Already	Environmentally preferable purchasing (EPP) Would Like
Local vendor preference	Local vendor preference Have Already	Local vendor preference Would Like
Pollution Prevention	Pollution Prevention Have Already	Pollution Prevention Would Like
Waste Management	Waste Management Have Already	Waste Management Would Like
Waste Reduction and Recycling	Waste Reduction and Recycling Have Already	Waste Reduction and Recycling Would Like
Water Quality/Protection	Water Quality/Protection Have Already	Water Quality/Protection Would Like

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* 8. Please check all of the activities that apply at your place of business:

Storing Materials Outside (salt, mulch, drums, etc.)

Food Preparation

Spill containment & response

Managing Wastes

Maintaining buildings & pavement

Maintaining constructed stormwater controls (ponds, basins, oil/water separators, etc.)

Maintaining landscapes

Site design and/or construction

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* 9. Please check all of the steps your organization utilizes to manage waste.

Purchasing decisions are made to minimize waste (e.g. excess materials and packaging are avoided).

Steps are taken to minimize waste when using chemical and petroleum produces (e.g., over-application is avoided and products are used completely).

Steps are taken to ensure that wastes are not dumped onto the ground or into a storm drain (e.g. contract language added to prohibit waste dumping outside, contractor training, etc.)

Wastes are reviewed for potential reuse or recycling. Wastes that cannot be reused or recycled are properly disposed.

An employee is designated to oversee recycling/waste management programs.

Composting food waste and other organics

Recycling bins are available for employee and customer use

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* 10. Which Environmental Excellence program(s) would you like to apply for?

Both Environmental Excellence Programs (CPCS & WK)

Community Partners for Clean Streams only

Waste Knot only

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