HHW CESQG Materials Reporting Indiana HHW Grant Program
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HHW CESQG Materials Reporting Indiana HHW Grant Program Form. This is a Indiana form and can be use in Department Of Enviromental Management Statewide.
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Tags: HHW CESQG Materials Reporting Indiana HHW Grant Program, 51989, Indiana Statewide, Department Of Enviromental Management
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
GRANT INFORMATION
Date:
Action Review Number (ARN):
Reporting Period (enter dates)
FROM:
TO:
Grantee:
Person Completing Report:
SECTION 2
Material
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
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
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