Office of Pollution Prevention and Technical Assistance Household Hazardous Waste Grant Progress Report HHW GRANT PROGRAM 402 West Washington Street, W041 Indiana HHW Grant Program P.O. Box 7095 State Form 51990 (11-04) Indiana Department of Environmental Management Indianapolis, IN 46207-7095 Internet: http://www.in.gov/idem/resources/ grants_loans/recycling/ INSTRUCTIONS: The Report Form is designed to satisfy standard grant reporting requirements. Grantee should consult Exhibit B. of their grant agreement for additional reporting requirements. Attach additional sheets if necessary and label attachments according to the number of the final report question. SECTION 1 GRANT INFORMATION Date: Action Review Number (ARN): Grantee: Person Completing Report: SECTION 2 REPORT QUESTIONS 1) Please summarize major activities performed during this reporting period. 2) Is the project proceeding according to the timeline submitted in the grant application? a) Explain any deviations from the submitted grant application. 3) Explain how the project’s goals are being achieved. 4) Attach a completed HHW/CESQG Materials Reporting form that summarizes shipment quantities to-date. 5) Are quantities of waste collected an increase or decrease? 6) How many households were served during the reporting period? a) 7) Is this an increase or decrease? How much? Provide an update on any activities from this grant for which the district is utilizing education or promotion funding. a) Based upon distribution of advertising, publications and other grant funded activities, please include an estimate of the public impact of each activity. 8) Address any additional reporting requirements if required by contract. 9) Attach a Grant Expenditure Report, summarizing all expenditures made to date. American LegalNet, Inc. www.FormsWorkflow.com