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2. Business Name
4. Type of Business/Description
6. Address 1
8. Address 2
10. City
11. Zip Code
13. Point of Contact Name/Title
15. Phone Number
16. Email Address
18. Check all that apply to your business' environmental activities:
20. 1. Recycling

    1. Aluminum/Tin
    2. Cardboard
    3. Glass
    4. Magazines/Phone Books
    5. Paper
    6. Plastic
    7. Printer/Toner Cartridges
    8. *Other
21. *Other:
    Describe other recycling activities.
23. 2. Sustainable Landscaping

    1. Compost
    2. Erosion Control Measures
    3. Flower Beds
    4. Mulching
    5. Native Plants
    6. *Other
24. *Other:
    Describe other sustainable landscaping measures.
26. 3. Beautification

    1. Formerly Neglected Site
    2. Signage
    3. Sustained Site
    4. *Other
27. *Other:
    Describe other beautification efforts.
29. 4. Other Innovative Enhancements

    1. Clean Energy
    2. Green Policies
    3. Stormwater Management
    4. Used Recycled/Green Products
    5. *Other
30. *Other:
    Explain other innovative environmental enhancements.
32. 5. Are you currently under investigation for environmental non-compliance?

    1. Yes
    2. No
33. If yes, please explain:
35. 6. Are you in compliance with your environmental permits?

    1. Yes
    2. No
36. If no, please explain:
38. 7. Are you using best management practices?

    1. Yes
    2. No
39. If yes, please describe:
41. 8. Additional information
45. For Office Use Only
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit Submit and Print

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