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Waste Knot Application Form

This is a Free, Non-Regulatory business assistance and recognition program.

Please include all information as you would like it to appear on your certificate and in Waste Knot publications:

To select multiple entries in a select box, hold down the control (Ctrl) key while making your selections

(fields with an asterisk * are required)

*Company:
*Address :
*City: *State: *Zip Code:

*Contact Person:
Title:
*Phone Number: Fax:
E-Mail Address:

# of Employees at this Location:
Website URL address:

How did you hear about this program?:

Chamber of Commerce Radio Newspaper Other

If you answered Other, please elaborate:

Type of company:

If you answered Other, please elaborate:

Section 1: Waste Reduction and Reuse

Waste Reduction is any activity which eliminates or reduces solid waste that would otherwise be thrown away or recycled.

Select all of the following activities that occur within your facility.

If you answered Other, please elaborate:
 

Reuse: Select all of the following items that are reused on a regular basis within your facility:

If you answered Other, please elaborate:

Waste Collection Information - Select the type of garbage service you use:

Contract with waste collection service
Property manager provides waste collection service
Garbage collection provided by the City
Self-haul garbage to a transfer station

Has your organization been able to decrease its garbage collection as a result of recycling?

Yes No Do not know

Section 2: Recycling

Select the materials that are recycled at your facility:

If you answered Other, please elaborate:

If you use a recycling collection service, list your recycling collector(s):

If you take the recyclables to a recycling facility, list the facility:

How many times a week is your recycling collected?

How many containers are collected?

Section 3: Using Recycled Content Products

Recycled Content Products are made with materials that have been used and collected for recycling. When you purchase recycled content products, you support the recycling process by creating a market for recyclable materials. From the list below, mark all the products you use that are made with recycled materials. If in doubt, ask your suppliers which of your products have been made with recycled materials.

If you answered Other, please elaborate:

Does your company have a formal purchasing policy regarding recycled products? (purchase of post-consumer content products, chlorine-free paper, etc.)
Yes No

Section 4: Education

Employee education is crucial to any effective waste reduction or recycling program. Please answer the following:

Has your organization issued a written statement defining preferred waste reduction and recycling practices?

 Yes No

Has your organization designated one or more employees to oversee your waste reduction and recycling program?

 Yes No

Does your organization introduce new employees to your waste reduction and recycling program?

 Yes No

Does your organization periodically remind and update employees about your waste reduction and recycling program?

 Yes No

Does your organization reward employees for participating in your waste reduction and recycling program?

 Yes No

Does your organization provide employees with incentives to develop new waste reduction ideas?

 Yes No

Section5: Energy Conservation

Please indicate the following activities you have engaged in:

Replacing incandescent light bulbs with compact fluorescent light bulbs
Purchacing ENERGY STAR-rated office equipment
Enabling ENERGY STAR features such as 'automatic sleep mode' on office equipment/PC's
Installing occupancy sensors in...
  Offices
  Restrooms
  Janitorial closets
  Conference spaces
  Other
Placing external lights on timers
Performing routine preventative maintenance on major equipment such as refrigeration units, chillers, boilers, air handling systems, etc.
Installing variable air volume (VAV) systems in heating and cooling equipment
Employing night setbacks and other temperature control measures when building is unoccupied
Replacing old fluorescent fixtures (with "fat" T12 bulbs and magnetics ballasts) with newer fixtures using T8 or T5 bulbs and electronic ballasts
"Right-sizing" motors and installing variable frequency drives wherever practicable
Other

Section 6: Additional Information

Why does your organization deserve special recognition as a Waste Knot Partner? Include any activities or practices that may not have been sufficiently covered in the above sections. Please inlcude information on any other sustainable environmental practices in which your business participates, including integrative pest management, use of less toxic alternatives, and energy efficiency. If applicable, provide any information about recycling rates, new programs and dollars saved from waste reduction and recycling practices (e.g. tons of paper collected, dollars per year saved, etc.):



As part of a continuing effort to assist Washtenaw County businesses, may we use the information provided in this application within case studies related to waste reduction and recycling practices.

 Yes No