Form Tceq 00784 – Fill Out and Use This PDF

PART 1. FACILITY DESCRIPTION

Report Year:		Report Date:
Company Name:
Facility Name:
Mailing Address:		Physical Address:
Mailing City, State, Zip:		Physical City, State, Zip:
Name of Pollution Prevention Contact:		TCEQ SW Reg. #
Telephone:		TRI ID #
Fax:		EPA ID #
E-mail (optional):		NAICS:
Primary SIC Code:		Number of Employees:
Secondary SIC Code:		Independently owned? ❑ Yes ❑ No
First year of your current plan:
Does this report revise a previously submitted APR? ❑ Yes	❑ No

PART 2. PROJECTED AMOUNTS FOR GOAL YEAR (FROM YOUR PLAN)

Goal Year (the fifth year of your plan): ____________
				Estimate Quantity
			HW (A)			TRI (B)
1.	Projected amount of HW generation or			Tons		Tons
	TRI releases/transfers by Goal Year
2.	Source reduction anticipated over five-year period			Tons		Tons
3.	% Waste Minimization by the Goal Year			%		%

TCEQ-00784 (11/10)

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Facility Name: ___________________________________________ Date: ______________________________________________

Part 3. Reduction Achievement for the Report Year

Source Reduction Activities

Estimate the amount of reduction for hazardous waste generation and TRI release/transfer that your facility experienced in each category below.

Estimate Quantity

HW (A) [Tons]

TRI (B) [Tons]

1.Good Operating Practices

2.Inventory Control

3.Spill and Leak Prevention

4.Raw Material Modifications

5.Process Modifications

6.Cleaning and Degreasing

7.Surface Preparation and Finishing

8.Product Modification

9.Total Source Reduction (Sum 1-8) in Tons

Briefly describe any modifications to your plan as well as your pollution prevention projects, especially the activity you undertook to reduce waste at it’s source for the report year:

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

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If your project was successful please complete the Optional Case Study Form at the end of this document and send it to us. TCEQ likes to recognize companies who have had great successes.

Note: Submission of waste minimization information and information about HW generated and TRI released and transferred for the previous reporting year is required by the Waste Reduction Policy Act. SQG’s that are non-TRI Form R reporters meet this requirement through submission of their annual waste summary. All hazardous waste generators are required to submit an annual waste summary. Submission of this form does not substitute for submission of the annual waste summary.

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