Household Hazardous Waste Grant Final Report Indiana HHW Grant Program {51991}

Office of Pollution Prevention and Technical Assistance HHW GRANT PROGRAM 402 West Washington Street, W041 State Form 51991 (11-04) P.O. Box 7095 Indiana Department of Environmental Management Indianapolis, IN 46207-7095 Internet: http://www.in.gov/idem/resources/ grants_loans/recycling/ INSTRUCTIONS: This Report Form is designed to satisfy standard grant reporting requirements. Grantee should consult Exhibit B. of their grant agreement for additional reporting requirements. Attach additional sheets if necessary and label attachments according to the number of the final report question. Household Hazardous Waste Grant Final Report Indiana HHW Grant Program SECTION 1 Date: Grantee: Person Completing Report: SECTION 2 1) Please provide a summary of grant funded activities. GRANT INFORMATION Action Review Number (ARN): REPORT QUESTIONS a) Were the goals outlined in the grant application attained? 2) How has participation been affected by the implementation of the project (e.g., do more households participate in the household hazardous waste program)? a) Indicate what the participation rates were before and after implementation and what assumptions went into this evaluation. 3) What dollar savings or improvements in operating efficiency have you achieved through implementation of the project? 4) Describe your program's source reduction activities. a) Which activities were the most successful? 5) If someone wanted to emulate your project, what information would be most helpful? a) Describe project successes and failures so others can learn from your project. 6) Education/promotion efforts: Provide a statistical report with an estimate on the public impact resulting from this project. (Include any written materials developed with grant funds.) a) What promotional materials worked well and why? (Please do not send promotional items such as used oil collection pan, t-shirts, etc.) b) Which items were not effective? c) How will you use this information to shape the future program? d) Provide samples of the program's education/promotion information? American LegalNet, Inc. www.FormsWorkflow.com 7) Facility operations only: Document the establishment of facility safety plans that satisfy the applicable portions of Special Conditions, Section C of Exhibit B. 8) Equipment or HHW storage shed purchases only: How did the grant funded equipment perform in meeting the goals of the project and expectations in terms of successful operation of the equipment (e.g., did the equipment require excessive maintenance or considerable down time)? a) Would you recommend the equipment for use in similar projects? Please note any recommendations for other communities that may be interested in implementing a similar project or program. b) Provide documentation of the establishment of an equipment replacement fund, as required in Special Conditions, Section B of Exhibit B. 9) Provide a copy of your sustainability plan, as required by your board resolution. (For regional or multi-county grants, each participant must submit a sustainability plan.) a) How much is set aside in your budget for HHW disposal/recycling and how much for education in the next year? b) What is your funding source (i.e. general line item or special fee) for this program to continue in the future? c) What fees have been considered or proposed within your district including other units of government (i.e. cities, towns) to support the program? 10) Attach a completed Grant Expenditure Report that details all expenditures made during the grant term. a) Attach documentation of all grant expenditures as required in Section 6. Payment Claim Process in your grant agreement. 11) Attach a completed HHW/CESQG Materials Reporting form that summaries all shipments of materials made during the grant term. American LegalNet, Inc. www.FormsWorkflow.com