Free 2006 HHW Program Data form.xls - Indiana

POLLUTION PREVENTION AND TECHNICAL ASSISTANCE

HOUSEHOLD HAZARDOUS WASTE (HHW) DATA INDIANA HHW GRANT PROGRAM
State Form 52509 (R / 8-07)

Source Reduction and Recycling Branch 100 N. Senate Avenue, Mail Code 64-01 Indianapolis, IN 46204-2251

http://www.in.gov/idem/resources/grants_loans/

INSTRUCTIONS: Enter HHW and CESQG program information for calendar year in indicated boxes.Call your grant representative for assistance with this report.

HHW Program Information Name of HHW Program: Program Type: Number of Tox-Away Days: Program Description: Hours Open to Public:
Enter total number of hours annually open to the public for HHW/Conditionally Exempt Small Quantity Generator collection (CWSQG). If single-day collection program, enter number of hours of HHW collection(s).
Tox-Away Day Facility Both

Number of Oil Collection Locations:

HHW Program Hours:

Please list days and hours open to public.

2006 HHW Data (January 1, 2006 through December 31, 2006) Education and Promotion:
Enter total dollar amount spent annually on household hazardous waste and conditionally exempt small quantity generator education and promotion. If necessary estimate dollars spent on HHW education and promotion, or Solid Waste Management Districts (SWMD's) may use Public Education and Promotion (PEP) grant and cash match dollars spent.

HHW Program Staff:
Enter dollar amount spent on staff devoted to HHW activities. Estimate proportion of staff time spent on HHW program education, collection and management activities; enter proportion of salary(s) including benefits (benefits average 35% of salary).

Contract Labor:
Enter dollar amount spent on contract HHW/CESQG labor. If your program uses contract labor to perform HHW activities, enter dollar amount; if contract labor is included in HHW disposal, leave this entry blank.

Supplies:
Enter dollar amount spent on HHW and CESQG program supplies, including safety and packaging.

Associated Collection Costs:
Enter other costs associated with HHW/CESQG collection. (Please use box at right to identify other expenditures.)

HHW Dollars Spent on Disposal:
Enter dollars spent on HHW and CESQG disposal or recycling.
Associated Collection Costs

Population:
Enter population of district or community service area.

Households:
Enter number of households in service area (may divide population by 2.5).

Disposal Customers:

Household

Business

Enter number of customers (HHW, Oil, CESQG, Universal Waste) served annually (the number of people, households and businesses that brought your program HHW, used motor oil, CESQG waste or universal waste such as fluorescent bulbs). Use estimate if necessary.

Reuse Customers:
Enter in box number of reuse customers served annually.
Continued on next page.

Waste Management Data

Numbers are in pounds unless noted.

Page 2.

INSTRUCTIONS: Identify number of pounds of the following wastes or materials. If quantity is not in pounds indicate unit of measure used. Most information can be found on on the bill of lading, manifest or invoice.

HHW and CESQG Data

Weight in pounds

Pharmaceuticals/Medicines: Liquid = 8 lbs./gallon; solid = 3 lbs./gallon (Example: 55 gallon drum = 440 lbs.) Oil base: Paint Recycling Gaylord = 1200 lbs.; D.O.T. Gaylord or cubic yard box = 850 lbs. Ballasts Flammable liquids: Poisons: Liquid and Solid (herbicides, pesticides): Aerosols: All other HHW/CESQG Wastes: Acids, bases, oxidizers, flammable solids, etc. Sealed containers (propane tanks, lbs.): Sub total: PCB:

Latex: Non PCB:

0

lbs.

Mercury
Fluorescent lamps (feet x .15 =lbs.): Aerosols Devices: Aerosols Debris: Elemental: Aerosols Mercury batteries: All other mercury items: Sub total:

0

lbs.

Automotive Products
Used motor oil (gallons x 8.5 = lbs.): Aerosols Antifreeze (gallons x 9.3 = lbs.): Aerosols Oil filters (55 gallon drum = 293 lbs.): Sub total:

0

lbs.

Batteries
Alkaline (lbs): Aerosols Rechargeable (lbs): Aerosols Other Hazardous Chemistry Batteries (lbs): Automotive (number of auto batteries): Sub total:

0

lbs.

Enter pounds of HHW Reused:
TOTAL HHW, CESQG, Mercury, Automotive, Batteries managed:
Continued on next page.

0

lbs.

Problem Waste Materials TIRES Enter number of car, truck and tractor tires collected in boxes to right. Car: Truck: Tractor:

Page 3.

Number of People Served Enter number of people served by tire recycling collections, please do not include in number used for HHW customers. Tire Recycling Contactor Dollars: Enter dollars amount spent with contractors to recycle tires. Tire Collections Staff Time: Enter dollar amount spent on staff devoted to tire activities: estimate proportion of staff time spent on tire education and collection activities; enter proportion of salary(s) including benefits (benefits average 35% of salary). Tire Recycling Income: Enter amount received from fees for tire collections. ELECTRONICS: Enter number of pounds of electronics collected. Number of People Served Enter number of people served by electronics collections, please do not include in number used for HHW customers. ELECTRONICS ACCEPTED Computer Equipment Small electronics Electronics Recycling Contactor Dollars: Enter dollar amount spent with contractors to recycle electronics. Electronics Collections Staff Time: Enter dollar amount spent on staff devoted to electronic collection activities. Estimate proportion of staff time spent on electronic program education, collection and management activities; enter proportion of salary(s) including benefits (benefits average 35% of salary). Electronics Recycling Income: Enter amount received from fees for electronics collections. (Check all you collect. ) Televisions

.
CFC Appliances WHITE GOODS Enter number of CFC containing appliances (refrigerators, freezers, air conditioners, dehumidifiers) collected. Other white goods Enter number of other white goods collected. Number of People Served Enter number of people served through white goods collections, please do not include in number used for HHW t White Goods Collections Staff Time: Enter dollar amount spent on staff devoted to white goods collection activities. Estimate proportion of staff time spent on white goods program education, collection and management activities; enter proportion of salary(s) including benefits (benefits average 35% of salary). White Goods Recycling Income: Enter amount received from fees for white goods collections. White Goods Recycling Contactor Dollars: Enter dollar amount spent with contractors to recycle electronics.

Continued on page 4.

Problem Waste Materials continued SHARPS Enter number of pounds of sharps collected.

Page 4.

Number of People Served Enter number of people served by sharps collections, please do not include in number used for HHW customers. Sharps Collection/Disposal Contactor Dollars: Enter dollar amount spent with contractors to manage sharps. Sharps Collections Staff Time: Enter dollar amount spent on staff devoted to sharps collection activities. Estimate proportion of staff time spent on sharps program education, collection and management activities; enter proportion of salary(s) including benefits (benefits average 35% of salary). Sharps Dsiposal Income: Enter amount received from fees for sharps collections.

COMMENTS / NOTES

Enter comments and notes in below box.