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. How many locations do you have in Washtenaw County?

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

Environmentally preferable purchasing (EPP)

Local vendor preference

Pollution Prevention

Waste Management

Waste Reduction and Recycling

Water Quality/Protection

Other(s) (please specify):

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* 7. 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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* 8. Which of the following waste management steps does your organization utilize 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.

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* 9. 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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