Free 53582.pdf - Indiana

INDIaNa CleaN maRINa pleDge
State Form 53582 (4-08)

INSTRUCTIONS: 1. Read and complete this form. 2. Mail the completed form to the above address.

Indiana Department of Natural Resources Lake Michigan Coastal Program Coastal Nonpoint Coordinator 1600 North 25 East Chesterton, IN 46304 Telephone: (219) 921-0863

The Indiana Clean Marina Program promotes and celebrates voluntary adoption of measures to prevent nonpoint source pollution from marinas and recreational boating and to prevent the spread of aquatic invasive species. Designated "Clean Marinas" are recognized as environmentally-responsible businesses. As the first step toward achieving Clean Marina status and on behalf of:
Name of Marina or Boatyard Address (number and street) City State ZIP Code

I pledge to do my part to keep Indiana's waterways free of harmful chemicals, excess nutrients, and debris, and to implement practices that prevent the spread of aquatic invasive species. I will identify opportunities and implement practices to control nonpoint source pollution associated with: · · · Storm Water Run-Off; Fueling Stations; Sewage Facilities; · Solid Waste; · Fish Waste; · Liquid Materials; · · · Petroleum Control; Boat Cleaning; and Boat Operation.

I commit to actively pursue full standing as an Indiana Clean Marina. Within one year of the date below, I will implement appropriate environmental stewardship practices and will apply to the Indiana Clean Marina Program for recognition as an Indiana Clean Marina.
Printed Name of Marina or Boatyard Owner Signature of Marina or Boatyard Owner Telephone Number Date (month, day, year) E-mail Address

Printed Name of Marina or Boatyard Manager Signature of Marina or Boatyard Manager Telephone Number

Date (month, day, year) E-mail Address

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