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Indiana CLEAN Community Challenge Annual Performance Report
State Form 53116 (R / 3-09)

Indiana Department of Environmental Management CLEAN Community Challenge

Indiana Department of Environmental Management Office of Pollution Prevention and Technical Assistance 100 North Senate Avenue IGCS W041 Indianapolis, IN 46204-2251 Telephone: (800) 988-7901 FAX: (317) 234-6573 www.cleancommunities.IN.gov

The Indiana CLEAN Community Challenge Annual Performance Report should demonstrate progress toward objectives and targets AND certify CLEAN Community Challenge requirements continue to be achieved. The Annual Performance Report should include the status of projects committed to in your community's original application, results of completed projects, and assurance that an annual Quality of Life Plan review was conducted by your community. Indiana CLEAN Communities must submit an Annual Performance Report two months after the anniversary of their CLEAN Community designation date. Please do not include any confidential community or business information in your Annual Performance Report. Public access laws require IDEM to make the Annual Performance Report publicly available, which may include posting all portions of your report on the Indiana CLEAN Community Challenge Web site. Your Annual Performance Report should be reviewed and signed by a senior manager at your community prior to submittal. Once signed, fax or mail the report to IDEM. If you have any questions, please contact the CLEAN Community Challenge Program Manager at 800-988-7901.

COMMUNITY INFORMATION Name of Community Street Address (number and street) City, State, ZIP Code Web site CONTACT INFORMATION Name of Contact Title Telephone number FAX number E-mail address Mailing Address (number and street) City, State, ZIP Code Reporting Period Dates (month, day, year) If this is your third Annual Performance Report, do you wish to renew your Indiana CLEAN Community Challenge designation? Yes No If yes, your community will need to provide five new objectives and targets in the Continual Environmental Improvement section of this report. ENVIRONMENTAL MEDIA ACTIVITIES Please identify the five objectives and targets in your Quality of Life Plan and describe the baseline measurement, the progress made during the past year, future plans for achieving each target, and any cost savings experienced as a result of the target. Environmental Media Activity #1 Objective Target Baseline Calendar year Calendar year Progress Made Progress made Progress made

Hurdles overcome Upcoming Plans to Achieve Target Cost Savings

If this is your third annual performance report, please provide the final results of this activity. If the objective and target were not achieved in the three year designation period, provide a description of why the objective and target was not met.

Environmental Media Activity #2 Objective Target Baseline Calendar year Calendar year Progress Made Progress made Progress made

Hurdles overcome Upcoming Plans to Achieve Target Cost Savings

If this is your third annual performance report, please provide the final results of this activity. If the objective and target were not achieved in the three year designation period, provide a description of why the objective and target was not met.

Environmental Media Activity #3 Objective Target Baseline Calendar year Calendar year Progress Made Progress made Progress made

Hurdles overcome Upcoming Plans to Achieve Target Cost Savings

If this is your third annual performance report, please provide the final results of this activity. If the objective and target were not achieved in the three year designation period, provide a description of why the objective and target was not met.

Environmental Media Activity #4 Objective Target Baseline Calendar year Calendar year Progress Made Progress made Progress made

Hurdles overcome Upcoming Plans to Achieve Target Cost Savings

If this is your third annual performance report, please provide the final results of this activity. If the objective and target were not achieved in the three year designation period, provide a description of why the objective and target was not met.

Environmental Media Activity #5 Objective Target Baseline Calendar year Calendar year Progress Made Progress made Progress made

Hurdles overcome Upcoming Plans to Achieve Target Cost Savings

If this is your third annual performance report, please provide the final results of this activity. If the objective and target were not achieved in the three year designation period, provide a description of why the objective and target was not met.

ANNUAL EMS AUDIT Summarize the results of the Annual EMS Audit your community performed on the Quality of Life Plan.

COMMUNITY AND BUSINESS OUTREACH Briefly describe the information presented to the community and businesses to keep residents informed of important issues related to the community's environmental performance, including how the status of Quality of Life Plan objectives were relayed to the community.

CONTINUAL ENVIRONMENTAL IMPROVEMENT If this is your third Annual Performance Report and your community desires to continue membership as an Indiana CLEAN Community, please provide five new objectives and targets your community will commit to during the next three year designation period, otherwise skip to the next section.

ADDITIONAL INFORMATION Please provide the following additional information. 1. List environmental awards received or voluntary programs participated in during the past twelve months (include information about each particular program). Has your community taken advantage of any CLEAN benefits? If so, please describe which benefits were used, the implementation process, and ideas for additional benefits IDEM should consider. Is your community pursuing ISO 14001 EMS certification? If yes, how has the Indiana CLEAN Community Challenge program been instrumental in achieving ISO 14001 EMS certification? Explain the measured or perceived results from receiving, documenting, and responding to external communication and its effect on Quality of Life Plan objectives and targets? Explain the emergencies experienced within the community during the past year. Were the applicable emergency and contingency plans detailed in the Quality of Life Plan effective? What changes, if any, have been made to your community's emergency or contingency plans? How have community residents and businesses reacted to your community participating in the Indiana CLEAN Community Challenge? According to the measurement program developed and implemented by your community to measure Quality of Life Plan success, is your community's Quality of Life Plan successful? Why or why not? If not, what changes will be made to ensure continual environmental improvement and future Quality of Life Plan success?

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CERTIFICATION AND PLEDGE I certify that the information contained in this Annual Performance Report and attachments is accurate to the best of my knowledge and that this local government is, to the best of my knowledge and based on reasonable inquiry, currently in compliance with all applicable federal, state, and local environmental requirements, or has a corrective action program in place to attain compliance. We, , commit to maintaining the principles and goals outlined in our Quality of Life Plan for our local government's Indiana CLEAN Community status. We agree to strive for full compliance with all regulations promulgated by U.S. EPA, the state, and/or local jurisdictions. We agree to promote the Indiana CLEAN Community Challenge and to share our success stories with other communities. We understand that the Annual Performance Report must be submitted to the local government and IDEM and that we must reapply to the Indiana CLEAN Challenge every three years. I understand that the information provided in this Annual Performance Report will be public record. I am the highest-ranking community official or I have been fully authorized by the highest-ranking community official to execute this statement on behalf of the local government submitting this Annual Performance Report. Signature Title Date (month, day, year)

Please submit your CLEAN Community Challenge Annual Performance Report to: IDEM-OPPTA CLEAN Community Challenge Program Manager 100 North Senate Avenue MC 64-00 IGCS W041 Indianapolis, IN 46204-2251 FAX: 317-234-6573