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HHW CESQG Materials Reporting Indiana HHW Grant Program 51989 - Indiana

HHW CESQG Materials Reporting Indiana HHW Grant Program Form. This is a Indiana form and can be used in Pollution Prevention Department Of Enviromental Management Statewide .
 Fillable pdf Last Modified 4/18/2007
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Office of Pollution Prevention and Technical Assistance HHW GRANT PROGRAM 402 West Washington Street, W041 State Form 51989 (11-04) P.O. Box 7095 Indiana Department of Environmental Management Indianapolis, IN 46207-7095 Internet: http://www.in.gov/idem/resources/ grants_loans/recycling/ INSTRUCTIONS: Report on all materials you collected, even if some materials were not grant funded. Methods may include reuse, recycling, treatment, incineration, or disposal. HHW/CESQG Materials Reporting Indiana HHW Grant Program SECTION 1 Date: Reporting Period (enter dates) Grantee: Person Completing Report: SECTION 2 Material Number of HHW Customers Number of Reuse Customers Number of CESQG Customers Reuse Materials Latex paint Oil base paint Aerosols Pesticides-solid Pesticides-liquid Flammable liquids Lab pack Propane tanks - 1 lb. Propane tanks - 20 lb. Photographic fixer Freon tanks Fire extinguishers Electronics Lead acid batteries (Auto) Alkaline batteries Hazardous properties batteries Syringes Pharmaceuticals Ballasts Capacitors Other GRANT INFORMATION Action Review Number (ARN): FROM: TO: HHW/CESQG MATERIALS COLLECTION DATA Totals of Materials Processed Average Price Method of Disposal During Grant Term Per Unit or Recycling Number or Pounds Name of Contractor American LegalNet, Inc. www.FormsWorkflow.com
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