EXAMPLE
SECTION II: IDENTIFY YOUR WASTE STREAMS
Fill out the table(s) below for each waste stream identified. Tables are provided for three waste streams.
Attach additional tables as necessary.
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SECTION I: TELL US ABOUT YOURSELF
1. Name of Organization: _____________________________________________________________
2. Street Address: ___________________________________________________________________
City: ______________ State: ______ Zip Code: ________________ County: _________________
3. Mailing Address (if different): ________________________________________________________
City: ______________ State: ______ Zip Code: ________________ County: _________________
4. Organization Website: _____________________________________________________________
5. Contact Name: __________________________________________________ (Mr. /Mrs./Ms./Dr.)
Tile: ____________________________________________________________________________
Phone: (____)_____________ Fax: (____)_______________ E-Mail: _________________________
6. EPA ID Number: ____________________________________
7. What do you do or make at your organization? Briefly describe the primary products you manufacture,
prepare, or assemble at your facility. For nonmanufacturing facilities, describe the services you provide or
the activities you conduct.
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
8. List the North American Industrial Classification System (NAICS) or Standard Industrial Classification
(SIC) codes that you use to classify business at your facility.
9. How many employees (full-time equivalents) currently work at your organization? ____________________
10. How were you recruited into OKStar?
Marketing mailer Through a trade association Market phone call or email
Internally within your company News media / professional journal From a peer in your sector
Environmental Consultant Other ______________________
Waste Stream Spent solvent cleaner (toluene, xylene)
Units Pounds
What is the current annual quantity 4,000
of this waste stream?
How is this waste stream managed? Disposal contract
What is your reduction goal? 50% reduction (2000 lb.)
What activities or process changes • Evaluate alternatives where feasible
do you plan to undertake at your • Purchase a solvent distillation unit
organization to accomplish your goal? and recycle spent solvent
SECTION III: TELL US ABOUT YOUR INTERNAL ENVIRONMENTAL PROGRAMS
A. Select the internal environmental programs that your organization currently uses or plans to implement.
Your internal environmental programs should focus on helping your employees (staff, students, and con-tractors)
to understand how their activities affect the environment, giving them opportunities to reduce
their impact on the environment, and empowering them to take action.
• Employee pollution prevention training and awareness program
• Employee environmental incentives. Examples include offering monetary rewards or recognition for envi-ronmental
performance and innovation
• Environmental Preferable Purchasing (EPP) Program, which involves integrating environmental factors into
procurement policies and procedures. Examples include buying products that reduce waste, have recycled
content, use less energy, are less toxic, and are more durable
• Employee waste reduction program. Examples include recycling or reusing office products like toner
cartridges, binders, and paper; accepting household recyclable items from employees; or donating un-needed
material to local charities
• A program to reduce employee commute trips to the workplace. Examples include offering
telecommuting, compressed work week, vanpooling and carpooling, or alerts on days with
high ozone levels
• Water conservation and efficiency education program
Waste Stream
Units
What is the current annual quantity
of this waste stream?
How is this waste stream managed?
What is your reduction goal?
What activities or process changes
do you plan to undertake at your
organization to accomplish your goal?
Waste Stream
Units
What is the current annual quantity
of this waste stream?
How is this waste stream managed?
What is your reduction goal?
What activities or process changes
do you plan to undertake at your
organization to accomplish your goal?
Waste Stream
Units
What is the current annual quantity
of this waste stream?
How is this waste stream managed?
What is your reduction goal?
What activities or process changes
do you plan to undertake at your
organization to accomplish your goal?
SECTION IV: TELL US ABOUT YOUR EXTERNAL COMMUNITY ENVIRONMENTAL SERVICE PROJECTS
A. Select the community environmental service projects in which organization currently participates or
plans to implement.
• Reducing waste in your community through activities such as:
• Supporting a community recycling program
• Participating in the Great American Cleanup™ , www.keepoklahomabeautiful.org
• Hosting a household hazardous waste collection event
• Adopting a highway section, www.okladot.state.ok.us/beauty/aahindex.htm
• Promoting sustainable lawn care
• Promoting water conservation through activities such as:
• Hosting a water efficiency or xeriscaping workshop
• Distributing low-flow plumbing fixtures and leak detecting devices
• Promoting rainwater collection
• Improving local water quality through activities such as:
• Sponsoring a public education campaign on nonpoint source pollution
• Encouraging employees to participate in Oklahoma Water Watch and Oklahoma Lake Sweep
www.owrb.state.ok.us/quality/monitoring/watch/wwatch.php
• Improving local air quality through activities such as:
• Hosting an Alternative Transportation Day
• Educating your community about ozone action days
• Promoting energy conservation through activities such as:
• Funding the distribution of compact fluorescent bulbs
• Promoting Energy StarTM or the use of renewable energy
• Educating your community about residential energy conservation
• Protecting habitat through activities such as:
• Supporting school, work, or community wildlife habitat projects, www.nwf.org
• Working with local groups to acquire and preserve habitat
• Designing, building, and distributing bird houses or butterfly houses
• Promoting environmental education through activities such as:
• Sponsoring or hosting continuing environmental education opportunities for area teachers
• Sponsoring a lecture series on environmental issues
• Other internal training and awareness programs:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________
B. Attach a description (200 to 300 words) of your existing internal environmental programs. You may
include items such as areas of training and awareness; how you identify training and awareness needs for
employees; how you increase awareness; how you ensure competence of employees; and how you offer
and identify specific incentives for environmental performance among employees.
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SECTION V: SENIOR MANAGEMENT COMMITMENT
PARTICIPATION STATEMENT
I, (name)______________________________________________, (title)____________________________of
(organization name)__________________________________________________________, certify that I have
personally examined all information provided in this application, including the attachments, and all information
provided is true, accurate, and complete, to the best of my knowledge.
I am a senior organization leader and have been duly authorized to execute this statement on behalf of the
organization applying for the OKStar Incentive program.
Signature of senior management:
_____________________________________________________________________________________
Phone number: (________)_______________________________________________________________
Title: _________________________________________________________________ Date: __________
• Supporting environmental education projects and programs in area schools
• Sponsoring environmental events such as:
• Hosting Pollution Prevention Week activities (in September), www.p2.org
• Sponsoring Earth Day activities (in April), www.earthday.net
• Other community environmental service projects:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________________________________________
B. Attach a description (200 to 300 words) of your external community environmental service projects. You
may include items such as the schedule for the event, the purpose of the event, the audience, partners
involved, and marketing tools.
Please return this form to:
Environmental Performance & Recognition Program
Oklahoma Department of Environmental Quality
Pollution Prevention Program
P.O. Box 1677
Oklahoma City, OK 73101-1677
Or fax to Dianne Wilkins at (405) 702-9101,
or e-mail to dianne.wilkins@deq.state.ok.us
