Application for a One-Day Household Hazardous Waste Collection

1. Applicant

2. Type of Applicant Organization

Civic Group

Local Government

Non-Profit Organization

Other (Specify: )

If the applicant is not a unit of local government, please submit proof that the appropriate governmental unit(s) (i.e., County Board, City Council, Village Mayor) is/are aware of and support(s) the project's scope. (See item 10 below.)

3. Proposed Collection Site Target Area

Name(s) of Town(s)/County/Township etc., included in the proposed collection area:

Total Population of target area and number of eligible households

Population:

Households:

4. Proposed Collection Site

Collection site requirements:

• Agency contractors require a large, open area with sufficent space to allow for semi-trailers, a large tent, several roll-offs and other equipment.
• A long queuing area with separate entrance and exit is required to accomodate traffic flow.
• IEPA personnel and contractors need access to the site from 12:00 noon Friday until midnight Saturday.

Please describe the proposed collection site and submit a photograph, sketch and map of the area. (See item 10 below.)

Proposed collection site (If the property owner of the site is someone other than the applicant, submit a letter of permission from the property owner. See item 10 below.)

Owner:

Address:

City:

"Normal" use of property:

Size (square footage):

Surrounding Land Use:

Traffic Access/Control around site:

5. Pre-Collection Day Organization

List local personnel available for pre-collection day organization (P.R., planning, etc.). Include what forms of advertising (e.g. newspaper, direct mail, flyers, etc.) will be used to promote the event and include a proposed time schedule.

6. Collection Day Assistance

Describe the types of local personnel available for collection day assistance (e.g. traffic control, greeting participants, surveying cars). Include any assistance to be provided by police and/or street departments.

7. Local Contribution

Please state the amount of any local contribution that would be able to be made toward the cost of the collection:

$

8. Not-for-profit Organizations

Submit a letter from not-for-profit organizations (e.g. Habitat for Humanity, Goodwill, Salvation Army) in your area that would be willing to accept new, unopened, useable household products (i.e. paint, yard chemicals, cleaning products) that are accepted at the collection. (See item 10 below.)

9. Other Information

Please include any other pertinent information or plans you may have in relation to this requested event:

10. Documentation

As noted above, some documentation cannot be submitted electronically and must be submitted by postal mail or in person, including:

• Proof that the appropriate governmental unit(s) (e.g. County Board, City Council, Village Mayor) is/are aware of and support(s) the project's scope (if the applicant is not a unit of local government). (See item 2 above.)
• A photograph, sketch and map of the area of the proposed collection site. (See item 4 above.)
• A letter of permission from the property owner (if the property owner of the site is someone other than the applicant). (See item 4 above.)
• A letter from not-for-profit organizations (e.g. Habitat for Humanity, Goodwill, Salvation Army) in your area that would be willing to accept new, unopened, useable household products (i.e. paint, yard chemicals, cleaning products) that are accepted at the collection. (See item 8 above.)

Send the supporting documentation requested above to:

Illinois Environmental Protection Agency
Bureau of Land #24
Waste Reduction Unit
1021 North Grand Avenue East
P.O. Box 19276
Springfield IL 62794-9276
Attn: David Saladino

Applicants are not chosen on a first-come, first-served basis. If you have any questions concerning this application, contact the Waste Reduction Unit at 217-785-8604, fax 217-782-9290 or send email to David Saladino.