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U.S. Environmental
National
Environ
Achieve
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Table of Contents
Completing Your Application: background Information
Completing Your Application: Section-by-Section Instructions. 5-21
Cover. 5
Section A ^_/
SectionB #_//
Section C. 12-17
Section D. 18-19
Section E 20-21
Completing Your Application: Final Steps.. 22-23
Environmental Performance Table. 24-27
Environmental Requirements Checklist. 28-33
Application Form. Appendix
Legend
We use the following symbols throughout the instructions.
Benefits
Important
Websites
References
Definitions
Phone numbers
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The Program
Description is
available at www.
performancetrack
.com
For questions about
the application
process, call
1-888-339-PTRK
(7875).
I. What does filling out the National Environmental
Achievement Track Application Form involve?
The National Environmental Achievement Track Application Form
Is designed to be easy for you to fill out while also providing EPA
with enough information to evaluate whether your facility is
eligible for the Achievement Track.
The application consists of five sections:
» Section A-Tell us about your facility
» Section B-Tell us about your Environmental Management
System (EMS)
Section C-Tell us about your past achievements and future
commitments
Section D-Tell us about your public outreach and reporting
Section E-Read the Participation Statement and sign the
Application
The first four sections (Section A through Section D) ask you to
tell us about your facility and qualifications. After completing these
four sections, you will need to complete and sign the Application
and Participation Statement (Section E), which certifies that you
have read, understand, and meet the participation requirements as
established in the National Achievement Track Program
Description. The Program Description is currently available
through the EPA Performance Track website, www.epa.gov/
performancetrack, or from the Performance Track Information
Center, toll-free at 1-888-339-PTRK (7875), or from
ptrack@indecon.com.
These instructionswhich follow the same order as the form
should help you complete the application and answer any
questions that you have.
2. Will I need to provide any confidential business
information in the form?
No, we do not want you to submit any confidential business
information (CBI) on your application. Please keep in mind that, if
your application 'is successful, it will be posted on the EPA
Performance Track website.
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National Environmental Achievement Track
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3. Can you tell me more about the National Environmental
Performance Track?
EPA developed the National Environmental Performance Track to
recognize and encourage top environmental performersthose
who go beyond compliance with regulatory requirements.
We are implementing the National Environmental Performance
Track at two levels:
« The first level, the National Environmental Achievement Track
(Achievement Track), recognizes facilities that consistently
meet their legal requirements and have implemented
substantial environmental management systems. It is also
designed to encourage facilities to achieve more by
continuously improving their environmental performance and
informing and involving the public.
» The second level, the National Environmental Stewardship Track
(Stewardship Track), is under development. It is being designed
to recognize and encourage broader and higher levels of
voluntary environmental performance than those expected
for the Achievement Track.
4. What benefits do I get for joining the National
Environmental Achievement Track?
Participants receive several benefits when they enter the
Achievement Track. These include recognition, access to
information sources, and other program incentives. To read about
the specific incentives, please look at the Benefits page on the EPA
Performance Track website, www.epa.gov/performancetrack.
5. What do I do if I have questions about the application
process or about the program in general?
If you have any questions or would like a detailed description of
the National Environmental Achievement Track, call the
Performance Track Information Center toll-free at
I -888-339-PTRK (7875) or e-mail ptrack@indecon.com. You can
also get current information through the EPA Performance Track
website, www.epa.gov/performancetrack.
Benefits in Brief
National
recognition
Low priority for
inspection
targeting
Access to Peer
Exchange
Networks
Streamlined
administrative
procedures
Streamlined
monitoring and
reporting
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Facility name
Provide the name of the facility applying for admission. If you are
submitting an application for multiple facilities in one corporation,
please call 1-888-339-PTRK.
Name of parent company (if any)
Fill in the name of the parent company, if your facility is
owned by another company;
a division of a larger company; or
» the responsibility of another company.
Street address
List the street address of your facility.
Street address (cont)
Complete the street address, if necessary.
City/State/Zip Code
List the city, state, and zip code of your facility.
Give us information about your contact person for the
National Environmental Achievement Track Program.
Name
Enter the name of the individual who may be contacted for
additional information about your facility's application.
Title
Give the title of the contact person.
Phone
List the telephone number of the contact person (including area
code).
Fax
Give the fax number for the .contact person (including area code).
E-mail
List the e-mail address (if any) for the contact person.
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I. What do you do or make at your facility?
Briefly describe the primary products that you manufacture,
prepare, or assemble at your facility. For non-manufacturing
facilities, describe the services you provide or activities you
conduct.
| The NAICS is a new
I classification that is
0 replacing the SIC code
system.
If you do not know if
your company meets
the SBA definition, you
may contact your local
SBA office or consult
www.sba.gov/regula-
tionslsiccodesl or
www.sba.gov/size/
GuideMml.
2. List the Standard Industrial Classification (SIC) codes or
North American Industrial Classification System (NAICS)
codes that you use to classify business at your facility.
If your facility has more than one SIC or NAICS code, please list
the primary code for the facility first, followed by all other codes.
If you do not know your facility's classification code, please consult
the following website: www.census.gov/epcd/www/naicstab.htm.
3. Does your company meet the Small Business Administra-
tion definition of a small business for your sector?
Check yes or no. For purposes of this question, your
"company" is your facility's parent company (as you have
identified on the cover page of the application). If you have
not identified a parent company, then answer the question
based on the size of your facility.
To qualify as a small facility, you must have fewer than 50
full-time equivalent (FTE) employees at your facility and your
company must meet the Small Business Administration (SBA)
definition.
4. How many employees (full-time equivalents) currently
work at your facility?
Check the box that best corresponds to the number of full-time
equivalent (FTE) employees working at the facility. An FTE
represents 2,000 hours per year. To calculate the number of FTEs,
add the total hours worked during the calendar year by all
employees, including part-time and seasonal employees, and divide
the total by 2,000.The answer is your FTE.
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5. Does your facility have an EPA ID number(s)?
Check yes or no.
If you checked yes, enter your facility's EPA ID number in the
space provided. Your facility may have more than one number. If
there is not enough room provided, list the additional IDs on a
separate piece of paper.
6. Identify the environmental requirements that apply to
your facility. Use the Environmental Requirements Checklist,
on pages 28-33 of the instructions, as a reference. List
your requirements to the right or enclose a completed
Checklist with your application.
This question asks you to identify the significant applicable major
federal, state, tribal, and local environmental requirements at your
facility. We've provided an Environmental Requirements Checklist on
pages 28-33 of the instructions to help you identify the
requirements that may be applicable at your facility. The Checklist
is not intended to be an exhaustive list, but rather a reference to a
number of federal, state, tribal, and local requirements that are
applicable to a wide range of facilities.
You may list your facility's requirements on the lines provided
(attach additional sheets of paper, if necessary) or you may
complete the Checklist and enclose it with your application.
7. Check the appropriate box in the right-hand column.
Check the box that corresponds to how you answered Question
6 - either by listing your facility's requirements or by enclosing the
Checklist with your application. This will help us determine whether
or not your application is complete.
8. Optional: Is there anything else you would like to tell us
about your facility?
This question is optional. Use this section to share other
information about your facility's environmental accomplishments
and activities that you believe would be useful. You may attach
additional sheets.
See the
Environmental
Requirements
Checklist on pages
28-33 of the
instructions.
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In this section, tell us about the Environmental Management System
(EMS) that your facility has in place and whether it meets specific
National Environmental Achievement Track elements.
We need to know about your EMS because it represents your facility's
systematic effort to meet its environmental requirements, maintain
compliance, and achieve performance objectives that may be related to
unregulated aspects of your facility's activities. In order for your facility
to qualify for the Achievement Track, your EMS must meet all of the
specific EMS elements listed below.
I. Check yes if your EMS meets the requirements for each
element below.
a. Environmental policy
Check yes, if your EMS includes a written environmental policy,
defined by top facility management, that includes commitments to
all of the following four elements:
I. Compliance with both legal requirements and voluntary
commitments;
2. Pollution prevention (based on a pollution prevention hierarchy
where source reduction is the first choice);
3. Continuous improvement in environmental performance,
including areas not subject to regulations; and
4. Sharing information about environmental performance and the
operation of your EMS with the community.
b. Planning
Check yes, if your EMS includes all of the following three planning
elements:
I. Identification of significant environmental aspects and
legal requirements, including procedures for integrating
anticipated changes to the facility's requirements or
commitments into the EMS.
2. Measurable objectives and targets to meet policy commitments
and legal requirements, to reduce the facility's significant
environmental impacts, and to meet the performance
commitments made as part of the facility's participation
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in the program.
In setting objectives and'targets, you should consider the following
criteria: preventing non-compliance, preventing pollution at its
source, minimizing cross-media pollutant transfers, and improving
environmental performance.
3. Active, documented programs to achieve the objectives, targets,
and commitments in your EMS, including the means and
time-frames for their completion.
c. Implementation and operation
Check yes, if your EMS includes all of the following six
i'mplementation and operation elements:
I. Established roles and responsibilities for meeting
objectives and targets of your overall EMS and compliance
with legal requirements, including a top management
representative with authority and responsibility for your EMS.
2. Defined procedures for:
Achieving and maintaining compliance and meeting
performance objectives;
Communicating relevant information about your
EMS, including the facility's environmental
performance, throughout the organization;
Providing appropriate incentives for personnel to
meet your EMS requirements; and
Maintaining document control, including where
documents related to your EMS will be stored and
who will maintain them.
3. General environmental training programs for all employees;
specific training for those whose responsibilities are directly
related to achieving objectives, targets, and compliance.
4. Documentation of the key EMS elements, including the
environmental policy, significant environmental aspects, objectives
and targets, a top management representative, compliance audit
program, EMS audit program, and overall EMS authority.
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5. Operation and maintenance programs for equipment and for
other activities that are related to legal compliance and other
significant environmental aspects.
6. An emergency-preparedness program.
d. Checking and corrective action
Check yes, if your EMS includes both of the following checking
and corrective action elements:
I. An active program for assessing performance and preventing
and detecting non-conformance with legal and other requirements
of your EMS, including an established compliance audit program
and an EMS audit program.
2. An active program for prompt, corrective action of any
non-conformance with legal requirements and other EMS
requirements.
e. Management review
Check yes, if your EMS has a documented management review of
performance against the established objectives and targets and of
the effectiveness of your EMS in meeting policy commitments.
! 2. Check yes, if your EMS has been in place through at least
» one "plan-do-check-act" cycle. A complete cycle includes:
I Defining and documenting your EMS;
'; Identifying significant environmental aspects and legal
I requirements;
i Setting measurable objectives and targets;
i Establishing roles and responsibilities for meeting EMS and legal
i requirements;
i Conducting training for personnel on EMS and legal
j requirements;
j » Undertaking steps to meet the established objectives and
| targets;
j Evaluating your progress in meeting the established objectives
and targets;
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Conducting an EMS audit;
Completing a compliance audit;
Correcting any areas of EMS non-compliance or legal
non-compliance;
Completing a management review of the EMS and its results.
3. Did this cycle include both an EMS and a compliance
audit?
Check yes if you have completed an audit of the EMS and an audit
of compliance with applicable federal, state, tribal, and local
environmental requirements.
4. Have you completed an objective self-assessment or
third-party assessment of your EMS?
Check the box corresponding to whether you completed an
objective self-assessment or a third-party assessment.
If you completed a self-assessment, indicate the protocol you
used by checking one of the boxes under "Self-assessment."
GEMI-Global Environmental Management Initiative
(www.gemi.org)
CEMP-Code of Environmental Management Principles
Self-Assessment Matrix (http://es.epa.gov/oeca/cemp/
cemptoc.html)
Other-Please fill in the blank with the method you
used.
If you completed a third-party assessment, indicate the protocol
you used by checking one of the boxes under "Third-party
assessment."
ISO 14001 Certification-International Standards
Organization 140001 Certification (www.iso.ch/)
Other-Please fill in the blank with the method you
used.
Useful websites:
www.gemi.org
http://es.epa.gov/
oeca/cemp/
cemptoc.html
www.iso.ch/
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See the
Env/ronmenta/
Performance Table
on pages 24-27 of
the instructions.
If you choose
accomplishments and
goals in aspects that
are currently regulated,
you must commit to
going beyond federal,
state, tribal, and local
regulatory
requirements.
See National
Environmental
Achievement
Track Program
Description, Section
IIA.2 for a full
description of
program criteria.
In this section, we need you to
» Demonstrate your facility's past achievements, and
Commit to reporting on future improvements at your facility.
To demonstrate past achievements and future improvements, you will
be using the Environmental Performance Table (on pages 24-27 of the
instructions).
The Environmental Performance Table includes a broad range of
environmental impacts. Not all of these impacts will be relevant to
your facility. In the table, we've captured the general types of
environmental impacts as "categories" and then broken them down
into more specific impacts we call "aspects." These "aspects" can be
quantified by the "measures" in the right-hand column.
The "measures" correspond to the numbers you will fill in on your
application. The measures that we've given in the table are some
common examples of quantities that can capture performance on
specific aspects. However, you are not limited to using the measures
that we've listed. If you have a different measure for capturing
performance on an aspect, you may use your measure when
completing the application. For example, if you are an automobile
manufacturer, the expected lifetime energy use of your product might
be most easily measured in gallons of gasoline, rather than Btus or
kWhs. In this case, you may report a goal or accomplishment in terms
of gallons of gasoline. Whatever measure you use, please state units
with all numbers.
It is important to remember that some of aspects are currently
regulated, and some are not. If you choose an aspect that is regulated,
then you must commit to performance goals that go beyond the
federal, state, tribal, and local regulatory requirements.
To demonstrate past achievements, select a minimum of two
environmental aspects from any of the categories in the
Environmental Performance Table (on pages 24-27 of the instructions).
Describe how your facility has improved its performance during the
current year and preceding year on those aspects. Feel free to
document performance achievements for more than two aspects.
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To commit to future improvements, you will select at least four !
environmental aspects from any of the categories in the !
Environmental Performance Table (on pages 24-27 of the instructions). \
You must commit to specific improvements over the next three years, j
The commitments you identify must go beyond any actions that you j
already take to comply with existing legal requirements at the federal, j
state, tribal, or local levels. !
1. Describe your past achievements for at least two
environmental aspects.
You can tell us about more past achievements by copying page 5
or 6 and attaching the extra sheets to your completed application.
First aspect you've selected
What aspect have you selected?
Use the Environmental Performance Table on pages 24-27 of the
instructions to choose your first aspect. Write the name of that
aspect (for example, energy use) in the gray area.
What was the previous level (2 years ago)?
In the gray area, write in the quantity and the units of the aspect
that you measured two years ago. Use an annual quantity if
possible. You may report an absolute quantity for the aspect (For
example, 800,000 mmBtu) or you may report a quantity in terms
of output or production (For example, 20 mmBtu per car pro-
duced).
If you qualify as a
small facility, you need
to report past
achievement for only
one environmental
aspect
To qualify as a small
facility, you must have
fewer than 50 FTE at
your facility, and
your company
must meet the
Small Bus/ness
Administration
definition of a small
business for your
sector.
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What is the current level?
In the gray area, write the corresponding quantity and the units of
the aspect for the most recent 12-month period for which you
have data.You may report an absolute quantity for the aspect (for
example, 864,000 mmBtu), or you may report a quantity in terms
of output or production (for example, 18 mmBtu per car
produced).
Whether you choose to report in absolute quantities or in terms
of output or production, you should express the quantity in the
same units for the previous level and for the current level.
i. How is the current level an improvement over the
previous level?
Explain why you consider the reported current quantity an
improvement. For example, the current quantity could show a
slight increase from past performance, but you may want to
explain that your production doubled over the same time period.
ii. How did you achieve this improvement?
Briefly describe the actions you took that caused the performance
improvements you reported above. Examples of these actions are
pollution prevention strategies, equipment upgrades, employee
training, or process changes. Be as specific as you can. If the
performance improvements were, in part, the result of your
participation in a voluntary program sponsored by the federal
government, your state or local government, or a
non-governmental organization, list that program here.
To complete the Past Achievements section: Fill out both Aspect
boxes under Question I, unless you are a small facility. If you are a
small facility, you can choose to complete only one.You can report
more than two aspects by copying page 5 or 6 and attaching the extra
sheets to your completed application.
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Example
First aspect you've selected
What aspect have
you selected?
Energy use
i. How is the current level a
previous level?
Thouah the values show
What was the previous
level?
Quantity Units
800,000 mmBtu
n improvement over the
a sliaht increase from the orevio
What is the
level?
Quantity
864,000
us level to
current
Units
mmBtu
the current level, our production doubled over the same time period.
ii. How did you achieve this improvement?
Pollution prevention strategies and eauioment uoarades.
2. Select at least four environmental aspects (no more than
two from any one category) from the Environmental
Performance Table in the instructions and then tell us
about your future commitments.
You can make additional commitments by copying page 6, 7, and 8
and attaching the extra sheets to your completed application.
If you qualify as a
small facility, you need
to make commitments
for at least two
environmental aspects
in two different
categories.
To qualify as a small
facility, you must have
fewer than 50 FTE at
your facility, and your
company must meet
the Small Business
Administration
definition of a small
business for your
sector.
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See the
Environmental
Performance Table
on page 24-27 of
the instructions.
If you need to, you
can refer to the
Planning portion of
the National
Environmental
Achievement
Track Program
Description,
(Section II.A.2), for
a full description
of program
requirements.
If you choose
accomplishments and
goals in aspects that
are currently regulated,
you must commit to
going beyond federal,
state, tribal, and local
regulatory
requirements.
First aspect you've selected
a. What is the aspect?
Use the Environmental Performance Table on pages 24-27 of the
instructions to choose your first aspect. Write the name of that
aspect (for example, energy use) in the gray area.
Choose significant aspects for future commitments that are
related to the objectives and targets in your EMS.
b. Is this aspect identified as significant in your EMS?
Check Yes if the aspect is one of those identified as a significant
aspect. Otherwise, check No.
c.What is the current level? You may choose to state this
as an absolute value or in terms of units of production or
output.
Write the quantity and the units of the aspect for the most recent
12-month period for which you have data. You may choose to
state this as an absolute value or in terms of units of production
or output. Check the box next to Option A if you are providing an
absolute value.Write the quantity and units on the line to the right
(for example, 864,000 mmBtu). Check the box next to Option B if
you are providing this level in terms of units of production or
output, and write the quantity on the line to the right (for
example, 18 mmBtu per car).
d.What is the level you are committing to achieve over
the next three years? You may choose to state this as an
absolute value or in terms of units of production or
output.
Write the future level of the aspect you are committing to. Check
the box next to Option A if you are providing this level as an
absolute value.Write the quantity and units on the line to the right
(for example, 691,200 mmBtu). Check the box next to Option B if
you are providing this level in terms of units of production or
output.Write the quantity on the line to the right (for example,
14.4 mmBtu per car,).
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e. How will you achieve this improvement?
Briefly describe the actions you will take to improve your
performance in this aspect. Examples of these actions are
equipment upgrades, employee training, and process changes. Be as
specific as you can. If the performance improvements are linked to
commitments you have made in a voluntary program sponsored by
the federal government, your state or local government, or a
non-governmental organization, list that program here.
To complete the Future Commitments section: Fill out the subsec-
tions for the second, third, and fourth aspect, unless you are a small
facility. If you are a small facility, you can choose to complete only the
subsection for the second aspect.You can make additional
commitments by copying page 6, 7, and 8 and attaching the extra sheets
to your completed application.
Example
First aspect you've selected
a.What is the aspect?
Energy use
b. Is this aspect identified as significant in your
EMS?
X Yes
No
c.What is the current ievel?You may choose to state this
as an absolute value or in terms of units of production
or output.
d.What is the level you are committing to achieve
over the next three years? You may choose to state
this as an absolute level or in terms of units of
production or output.
e. How will you achieve this improvement?
17
Option A:
Absolute value
Option B:
In terms of
units of production
or output
Option A:
Absolute value
X Option B:
In terms of units
of production
or output
(Quantity/Units)
18 mmBtu per car
(Quantity/Units)
(Quantity/Units)
14.4 mmBtu per car
(Quantity/Units)
Equipment upgrades and process changes.
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See the National
Environmental
Achievement Track
Program Description,
Section 1IA3, "Public
Outreach and
Performance
Reporting" for a full
description of program
requirements.
In this section, tell us about your commitment to public outreach.
I. How do you identify and respond to community
concerns?
Describe in one or two sentences how you identify and respond
to community concerns. (For example, "We hold an open house
every six months to discuss issues with the community.")
; 2. How do you inform community members of important
1 matters that affect them?
!
Describe in one or two sentences how you inform community
members of important matters. (For example, "We send out a
monthly newsletter detailing important issues.")
3. How will you make the Achievement Track Annual
Performance Report available to the public?
Tell us the way(s) that you will most likely distribute your Annual
Performance Report by checking one or more of the boxes. If you
will be using a website, provide the URL. If'Other', please describe
what will be done.
4. Are there any ongoing citizen suits against your facility?
Check Yes or No. For the purposes of this question, we are
referring to suits relating to environmental issues only. If there are
any ongoing environmental citizen suits or other legal actions,
briefly describe their current status.
5. List references below.
We may call references to learn more about your facility. Please
write the name of the person, the organization that the person
represents, and telephone number. A person who is associated
with your facility and who is also a member of a community/citizen
group cannot be used as a reference. See below for further
explanation about the kinds of references you can include.
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Representative of a community/citizen group.
Name a person representing a community/citizen
group based in your facility's community. Examples
include civic groups, neighborhood associations, local
chapters of environmental groups, and community
development organizations. Consider choosing a
reference from a community/citizen group that is
familiar with your facility either through proximity (e.g.,
a group representing an adjacent neighborhood) or
other involvement with the facility (e.g., a group with
representation on a facility's community advisory
committee).
State/ tribal! local regulator.
Name a person who is a regulator familiar with your
facility. This person does not have to be associated
with an environmental regulatory agency or
department. For example, other appropriate regulatory
agencies include those associated with public health or
housing.
Other community I local reference.
Name a person who is either an additional reference from one
of the two categories above or a reference familiar with your
facility and who represents another type of organization in the
community. Potential references include a member of the
Local Emergency Planning Committee (LEPC), a local labor
union member, a representative from the local Chamber of
Commerce, a university faculty member, or another business
owner or operator.
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See the National
Environmental
Achievement Track
Program Description,
Section II.A.3, "Public
Outreach and
Performance
Reporting" for a full
description of program
requirements.
To be able to sign the
Participant Statement,
you must meet certain
requirements detailed
to the right
In this section, read over the Participation Statement and then sign the
Application. When you sign the Application, it means that you are
familiar with the requirements of the program and you agree to fulfill
them if you are accepted. It also means that all the information you
have included in your Application is true and accurate.
By signing this statement, you are telling us that your facility
Is eligible for the Achievement Track program because it
complies with all applicable federal, state, tribal, and local
environmental requirements. (To make sure that your
program is eligible, you should assess your facility's compliance
record using the same screening criteria that EPA, and its state
partners, will use.These criteria are listed on the next page);
Has an EMS that meets all the specified requirements, and that
you will keep in place as long as your facility participates in the
program; and
Has undergone an objective compliance assessment, and that
you have corrected any noncompliance you may have found.
By signing this statement, you are also telling us that you understand
that
EPA can accept or remove you from the program at any time,
and that you do not have a right to challenge this
decision; and
Your facility's participation in the program is not relevant to
any legal enforcement proceedings for violations of
environmental requirements.
By signing the Participation Statement, you are confirming that you:
have enough knowledge of the facility to truthfully and accu-
rately execute the certification;
and are authorized on behalf of the applicant organization to
sign the statement; and
are in a senior position with a significant level of management
responsibility for the facility.
If, during consultation with EPA about your application, you decide to
submit revisions to your application, you must also resubmit Section E
with an original, dated signature.
Page 20
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National Environmental Achievement Track
www.epa.gov/performancetrack
l-888-339-PTRK(7875)
Screening Criteria j
Please use the following criteria to judge whether your facility is eligible j
to participate in the National Environmental Achievement Track. Your j
facility should not participate if a compliance screen shows any of the j
following, under federal or state law:
Corporate criminal conviction or plea for environmentally-
related violations of criminal laws involving the corporation or
a corporate officer within the past 5 years
Criminal conviction or plea of employee at your facility for
environmentally-related violations of criminal laws within the
past 5 years
Ongoing criminal investigation/prosecution of corporation,
corporate officer, or employee at your facility for violations of
environmental law within the past 5 years
Three or more significant civil violations at your facility in the
past 3 years
Unresolved, unaddressed Significant Non-compliance (SNC)
or Significant Violations (SV) at the facility
Planned, but not yet filed, judicial or administrative action at
your facility
Ongoing EPA or state-initiated litigation at your facility
» Situation where a facility is not in compliance with the
schedule and terms of an order or decree
In addition, we may also consider whether there are significant
problems, or a pattern of non-compliance, in an applicant's overall civil
or criminal compliance history.
The term
"significant" refers to
how different media
enforcement policies
characterize the
violation. To find out
more about this, please
see www.epa.gov/oeca/
main/strategy.
Page 21
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I. How do I know if my application is complete?
A complete Application for the Achievement Track Program
consists of
A fully completed Application Form,
A completed Environmental Requirements Checklist (if used)
or its equivalent (if used), and
A signed Achievement Track Program Application and
Participation Statement.
For questions about
the application
process, call
1-888-339-PTRK
(7875).
2. How do I submit my application?
E-mail your completed application with "Achievement Track
Application" in the subject line to www.ptrack@indecon.com.
Mail a hard copy of your completed application with original
signatures to:
The Performance Track Information Center
c/o Industrial Economics Incorporated
4th floor
2067 Massachusetts Avenue
Cambridge, MA 02140
3. What do I do if I have questions about the application
process?
If you have any questions about the application process, you can
call the Performance Track Information Center toll-free at
1-888-339-PTRK (7875), or you can e-mail questions to
www.ptrack@indecon.com.
4. What happens after I submit my application?
You will be notified when your application is received.Your
application will be reviewed by representatives from EPA
headquarters and regional offices. Through the appropriate regional
office, EPA will consult with the state where your facility is located
to help determine your facility's eligibility for the program.
Page 22
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National Environmental Achievement Track
www.epa.gov/performancetrack
l-888-339-PTRK(7875)
5. About how long will it take for EPA to review my
application?
It will take EPA approximately 90 days to review your application
and tell you its decision.
Page 23
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The Environmental Performance Table is based on the Global Reporting Initiative (GRI), an international
standard for voluntary corporate sustainability reporting. The GRI has been developed by an
international coalition of industrial firms, financial and accounting organizations, and environmental
groups. For more information on GRI, see www.globalreporting.org.
The Environmental Performance Table includes a broad range of environmental impacts. Not all of these
impacts will be relevant to your facility. In the table, we've captured the general types of environmental
impacts as "categories" and then broken them down into more specific impacts we call "aspects." These
"aspects" can be quantified by the "measures" in the right-hand column.
The "measures" correspond to the numbers you will fill in on your application. The measures that
we've given in the table are some common examples of quantities that can capture performance on
specific aspects. However, you are not limited to using the measures that we've listed. If you have a
different measure for capturing performance on an aspect, you may use your measure when completing
the application. For example, if you are an automobile manufacturer, the expected lifetime energy use of
your product might be most easily measured in gallons of gasoline, rather than Btus or kWhs. In this
case, you may report a goal or accomplishment in terms of gallons of gasoline. Whatever measure you
use, please state units with all numbers.
It is important to remember that some of these aspects are currently regulated, and some are not. If
you choose an aspect that is regulated, then you must commit to performance goals that go beyond the
regulatory requirements.
The following acronyms are used in the Environmental Performance Table:
BOD
COD
Btu
EPCRA
kWh
mmBtu
ppm
RQ
VOC
Biological Oxygen Demand
Chemical Oxygen Demand
British Thermal Units
Emergency Preparedness and Community Right-to-Know Act
Kilowatt Hours
Million Metric British Thermal Units
Parts per million
Reportable Quantity under the Comprehensive Environmental Responsibility and
Cleanup Act (CERCLA)
Volatile Organic Compounds
Page 24
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Category
Energy Use
Water Use
Materials Use
Air Emissions
(including motor
vehicle emissions)
Aspect
Total Energy Use
Total Water Use
Total Materials Use
Hazardous Materials Use
Recycled/Reused
Materials Use
Emissions of Greenhouse
Gases
Emissions of Ozone
Depleting Gases
Emissions of VOCs
Emissions of NOx
Measure
Btu/mmBtu
KwH
Megawatts
gallons
tons, metric tons
Ibs
tons,-metrictons
Ibs
tons, metric tons
Ibs
tons, metric tons
Ibs
ppm
tons, metric tons
Ibs
ppm
tons, metric tons
Ibs
ppm
tons, metric tons
Ibs
ppm
Environmental Performance Table continues on the next two pages
Page 25
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Category
Air Emissions, continued
(including motor vehicle
emissions)
Waste
Preservation/Restoration
Aspect
Emissions of Sulfur Dioxide
Emissions of Particulate
Matter
Emissions of Carbon
Monoxide
Emissions ofToxics
Total Solid Waste
Hazardous Solid Waste
Toxic Releases to Land
Removal
Remediation
Habitat Impacts
Measure
tons, metric tons
Ibs
ppm
tons, metric tons
Ibs
ppm
tons, metric tons
Ibs
ppm
tons, metric tons
Ibs
ppm
tons, metric tons
Ibs
drums
tons, metric tons
Ibs
drums
tons, metric tons
Ibs
drums
cu yds
tons, metric tons
sq ft
acres
sqft
acres
Page 26
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Category
Discharges to Water
Aspect
COD Discharges to Water
BOD Discharges to Water
Discharges ofToxics to
Water
Measure
Ibs
Ibs
Ibs
gallons/day
Accidental Releases
Release History
number
quantity of RQ, accidental
releases reported under
EPCRA
Vulnerability and
Potential for Releases
square feet (size of
Vulnerable Zone)
acres (size ofVulnerable
Zone)
drums (of hazardous
substances)
gallons (of hazardous
substances)
Product Performance
Expected Lifetime Energy Use
of Product
KwH
Btu, mmBtu
megawatts
Expected Waste (to air, water,
land) of Product
tons, metric tons
Ibs
Packaging Materials Used in
Product
tons, metric tons
Ibs
Waste to Air,Water, Land from
Disposal or Recovery of
Product
tons, metric tons
Ibs
gallons
ppm
Page 27
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-------
We've included the following Checklist to help you answer questions in Section A, Tell us about your
facility. This Checklist will help you identify the major federal, state, tribal, and local environmental
requirements that apply at your facility, but it is not an exhaustive list of all environmental requirements
that may be applicable at your facility.
If you use this Checklist and choose to submit it with your application, fill in your facility information
below and enclose the completed Checklist with your application.
Air Pollution Requirements
Check all that apply.
Q I. National Emission Standards for Hazardous Air Pollutants (40 CFR 61)
Qj 2. Permits and Registration of Air Pollution Sources
n 3. General Emission Standards, Prohibitions, and Restrictions
[]] 4. Control of Incinerators
fj] 5. Process Industry Emission Standards
Q 6. Control of Fuel Burning Equipment
G 7. Control of VOCs
Q 8. Sampling,Testing, and Reporting
G 9. Visible Emissions Standards
Q 10. Control of Fugitive Dust
Q II. Toxic Air Pollutants Control
Q 12. Vehicle Emissions Inspections and Testing
Other (you must list these)
Q 13. Other Federal, State.Tribal, or Local Regulations not listed above.
Hazardous Waste Management Regulations
Check all that apply.
G I. Identification and listing of hazardous waste (40 CFR 261)
Q -Characteristic waste
r~| -Listed Waste
-------
n 2. Standards Applicable to Generators of Hazardous Waste (40 CFR 262)
O -Manifesting
O -Pre-transport requirements
O -Record-keeping/Reporting
[U 3. Standards Applicable to Transporters of Hazardous Waste (40 CFR 263)
Q -Transfer facility requirements
O -Manifest system and Record-keeping
Q -Hazardous waste discharges
[H 4. Standards for Owners and Operators of TSD Facilities (40 CFR 264)
I | -General facility standards
O -Preparedness and prevention
O -Contingency plan and emergency procedures
D -Manifest system, record-keeping, and reporting
O -Groundwater protection
[~| -Financial requirements
I I -Use and management of containers
O -Tanks
Q -Waste piles
n -Land treatment
Q -Incinerators
H] 5. Interim Standards for TSD Owners and Operators (40 CFR 265)
[~] 6. Interim Standards for Owners and Operators of New Hazardous Waste Land
Disposal Facilities (40 CFR 267)
Q /.Administered Permit Program (Part B) (40 CFR 270)
Other (you must list these)
[H 8. Other Federal, State.Tribal, or Local Regulations not listed above.
Page 2P
-------
Hazardous Materials Management
Check all that apply.
Q 1. Control of Pollution by Oil and other Hazardous Substances (33 CFR 153)
Q 2. Designation of Reportable Quantities and Notification of Hazardous Materials Spill
(40 CFR 302)
O 3. Hazardous Materials Transportation Regulations (49 CFR 172-173)
D 4. Worker Right-to-Know Regulations (29 CFR 1910.1200)
G 5. Community Right-to-Know Regulations (40 CFR 350-372)
Other (you must list these)
[]J 6. Other Federal, State.Tribal, or Local Regulations not listed above.
Solid Waste Management
Check all that apply.
O I. Criteria for Classification of Solid Waste Disposal Facilities and Practices
(40 CFR 257)
O 2. Permit Requirements for Solid Waste Disposal Facilities
0 3. Installation of Systems of Refuse Disposal
fj 4. Solid Waste Storage and Removal Requirements
n 5. Disposal Requirements for Special Wastes
Other (you must list these)
Q] 6. Other Federal, State.Tribal, or Local Regulations not listed above.
Water Pollution Control Requirements
Check all that apply.
n I Oil Spill Prevention Control and Countermeasures (SPCC) (40 CFR I 12)
fj] 2. Designation of Hazardous Substances (40 CFR I 16)
Q| 3. Determination of Reportable Quantities for Hazardous Substances (40 CFR I 17)
n 4. NPDES Permit Requirements (40 CFR 122)
D 5. Toxic Pollutant Effluent Standards (40 CFR 129)
O 6. General Pretreatment Regulations for Existing and New Sources (40 CFR 403)
Name of POTW
ID # of POTW
Page 30
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I |
7. Organic Chemicals Manufacturing Point Source Effluent Guidelines and Standards
(40CFR4I4)
8. Inorganic Chemicals Manufacturing Point Source Effluent Guidelines and
Standards (40 CFR4I5)
9. Plastics and Synthetics Point Source Effluent Guidelines and Standards
(40CFR4I6)
10. Water Quality Standards
II. Effluent Limitations for Direct Dischargers
12. Permit Monitoring/Reporting Requirements
1 3. Classifications and Certifications of Operators and Superintendents of Industrial
Wastewater Plants
14. Collection, Handling, and Processing of Sewage Sludge
15. Oil Discharge Containment, Control, and Cleanup
1 6. Standards Applicable to Indirect Discharges (Pretreatment)
Other (you must list these)
Q 1 7. Other Federal, State.Tribal, or Local Regulations not listed above.
Drinking Water Regulations
Check all that apply.
O I. Underground Injection and Control Regulations, Criteria, and Standards (40 CFR
144, 146)
Q 2. National Primary Drinking Water Standards (40 CFR 141)
Q 3. Community Water Systems Monitoring and Reporting Requirements (40 CFR 141)
O 4. Permit Requirements for Appropriation/Use of Water from Surface or Subsurface
Sources
Q] 5. Underground Injection Control Requirements
[D 6. Monitoring, Reporting, and Record-keeping Requirements for Community Water
Systems
Other (you must list these)
Qj 7. Other Federal, State.Tribal, or Local Regulations not listed above.
-------
Toxic Substances
Check all that apply.
n
I. Manufacture and Import of Chemicals, Record-keeping, and Reporting
Requirements (40 CFR 704)
2. Import and Export of Chemicals (40 CFR 707)
3. Chemical Substances Inventory Reporting Requirements (40 CFR 710)
4. Chemical Information Rules (40 CFR 712)
5. Health and Safety Data Reporting (40 CFR 716)
6. Pre-manufacture Notifications (40 CFR 720)
7. PCB Distribution Use, Storage, and Disposal (40 CFR 761)
8. Regulations on Use of Fully Halogenated Chlorofluoroalkanes (40 CFR 762)
9. Storage and Disposal of Waste Material Containing TCDD (40 CFR 775)
Other (you must list these)
Q 10. Other Federal, State.Tribal, or Local Regulations not listed above.
Pesticide Regulations
Check all that apply.
D ' FIFRA Pesticide Use Classification (40 CFR 162)
O 2. Procedures for Storage and Disposal of Pesticides and Containers (40 CFR 165)
Q 3. Certification of Pesticide Applications (40 CFR 171)
I I 4. Pesticide Licensing Requirements
Q 5. Labeling of Pesticides
Q 6. Pesticide Sales, Permits, Records, Application, and Disposal Requirements
Q] 7. Disposal of Pesticide Containers
[I] 8. Restricted Use and Prohibited Pesticides
Other (you must list these)
O 9. Other Federal, State.Tribal, or Local Regulations not listed above.
Page 32
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Environmental Clean-up, Restoration, and Corrective Action
n I. Comprehensive Environmental Response, Compensation, and Liability Act
(Superfund). Please identify.
2. RCRA Corrective Action
3. Other Federal, State,Tribal, or Local Environmental Clean-up, Restoration,
Corrective Action Regulations Not Listed Above.
Facility name:
Facility location:
Facility ID numbers:
Page 33
-------
National
Environmental
U.S. Environmental Protection Agency
Application Form
Name of facility
Name of parent company (if any)
Street address
Street address (cont.)
City/State/Zip code
Give us information about your contact person for the
National Environmental Achievement Track Program.
Name
Title
Phone
Fax
E-mail
-------
Why do we need this information?
EPA needs background information on your facility to
evaluate your application.
What do you need to do?
* Provide background information on your facility.
Identify your environmental requirements.
What do you do or make at your facility?
2 List the Standard Industrial Classification (SIC) codes or
North American Industrial Classification System (NAICS)
codes that you use to classify business at your facility.
SIC
NAICS
Does your company meet the Small Business
Administration definition of a small business for your
sector?
Yes
No
How many employees (full-time equivalents) currently
work at your facility?
Fewer than 50
50-99
100-499
500-1,000
More than 1,000
Application for the National Environmental Achievement Track
OMB Ns. 2010-0032
-------
Does your facility have an EPA ID number(s) ?
Yes
No
If yes, list in the right-hand column.
Identify the environmental requirements that apply to
your facility. Use the Environmental Requirements
Checklist, at the back of the instructions, as a reference.
List your requirements to the right or enclose a
completed Checklist with your application.
7 Check the appropriate box in the right-hand column.
I've listed the requirements above.
I've enclosed the Checklist with my
application.
g Optional: Is there anything else you would like to tell us
about your facility?
Application for the National Environmental Achievement Track
OMB No. 2010-0032
Page)
-------
Why do we need this information?
Facilities need to have an operating Environmental
Management System (EMS) that meets certain
requirements.
What do you need to do?
Confirm that your EMS meets the Achievement
Track requirements.
« Tell us if you have completed a self-assessment or
have had a third-party assessment of your EMS.
Check yes if your EMS meets the requirements for each
element below as defined in the instructions.
':~ Environmental policy-
Yes
Planning
Yes
Implementation and operation
Yes
, Checking and corrective action -
Yes
Management review
Yes
'? Have you completed at least one EMS cycle
(plan-do-check-act) ?
': Did this cycle include both an EMS and a compliance
audit?
Have you completed an objective self-assessment or
third-party assessment of your EMS?
If yes, what method of EMS assessment did you use?
Yes
Yes
Yes
Self-assessment
GEMI Other
CEMP
Third-party assessment
ISO 14001 Certification
Other
Application for the National Environmental Achievement Track
OMB No. 2010-0032
-------
Why do we need this information?
Facilities need to show that they are committed to
improving their environmental performance.This means that
you can describe past achievements and will make future
commitments.
What do you need to do?
Refer to the Environmental Performance Table in the instructions to
answer questions I and 2.
j Describe your past achievements for at least two
environmental aspects. If you need more space than is
provided, attach copies of this page.
Note to small facilities: If you qualify as a small facility as
defined in the instructions, you need to report past
achievement for at least one environmental aspect.
First aspect you've selected
What aspect have
you selected?
What was the previous level
(2 years ago)?
Quantity Units
What is the current level?
Quantity
Units
i. How is the current level an improvement over the
previous level?
ii. How did you achieve this improvement?
Application for the National Environmental Achievement Track
OMB No. 2010-0032
Page 5
-------
Second aspect youVe selected
What aspect have
you selected?
What was the previous level
(2 years ago)?
Quantity Units
What is the current level?
Quantity
Units
i. How is the current level an improvement over the
previous level?
ii. How did you achieve this improvement?
Application for the National Environmental Achievement Track
OMB No. 2010-0032
-------
Select at least four environmental aspects (no more
than two from any one category) from the Environmen-
tal Performance Table in the instructions and then tell us
about your future commitments. If you need more space
than is provided, attach copies of this page.
Note to small facilities: If you are a small facility, you
need to make commitments for at least two
environmental aspects in two different categories.
First aspect you've selected
a.What is the aspect?
b. Is this aspect identified as significant in your EMS?
c.What is the current level? You may choose to state
this as an absolute value or in terms of units of
production or output.
d.What is the level you are committing to achieve over
the next three years? You may choose to state this
as an absolute level or in terms of units of
production or output.
e. How will you achieve this improvement?
Yes
No
Option A:
Absolute value
Option B:
In terms of units
of production
or output
Option A:
Absolute value
Option B:
In terms of units
of production
or output
(Quantity/Units)
(Quantity/Units)
(Quantity/Units)
Second aspect you've selected
a.What is the aspect?
b. Is this aspect identified as significant in your EMS?
Yes
No
Second aspect continues on the next page.
Application for the National Environmental Achievement Track
OMB No. 2010-0032
Page 7
-------
c.What is the current level? You may choose to state
this as an absolute value or in terms of units of
production or output.
d.What is the level you are committing to achieve
over the next three years? You may choose to state
this as an absolute level or in terms of units of
production or output.
e. How will you achieve this improvement?
Option A:
Absolute value
Option B:
In terms of units
of production
or output
Option A:
Absolute value
Option B:
In terms of units
of production
or output
(Quantity/Units)
(Quantity/Units)
(Quantity/Units)
Third aspect you've selected
a.What is the aspect?
b. Is this aspect identified as significant in your EMS?
c.What is the current level? You may choose to state
this as an absolute value or in terms of units of
production or output.
Yes
No
d.What is the level you are committing to achieve
over the next three years? You may choose to state
this as an absolute level or in terms of units of
production or output.
e. How will you achieve this improvement?
Option A:
Absolute value
Option B:
In terms of units
of production
or output
OptionA:
Absolute value
Option B:
In terms of units
of production
or output
(Quantity/Units)
(Quantity/Units)
(Quantity/Units)
Application for the National Environmental Achievement Track
OMB No. 2010-0032
-------
Fourth aspect you've selected
a.What is the aspect?
b. Is this aspect identified as significant in your EMS?
c.What is the current level? You may choose to state
this as an absolute value or in terms of units of
production or output.
d.What is the level you are committing to achieve
over the next three years? You may choose to state
this as an absolute level or in terms of units of
production or output.
e. How will you achieve this improvement?
Yes No
Option A:
Absolute value
Option B:
In terms of units
of production
or output
OptionA:
Absolute value
Option B:
In terms of units
of production
or output
(Quantity/Units)
(Quantity/Units)
(Quantity/Units)
Application for the National Environmental Achievement Track
OMB No. 2010-0032
Page?
-------
Why do we need this information?
Facilities need to demonstrate their commitment to public
outreach and performance reporting. You should have
appropriate mechanisms in place to identify community
concerns, to communicate with the public, and to provide
information on your environmental performance.
What do you need to do?
Describe your approach to public outreach.
List three references who are familiar with your facility.
i How do you identify and respond to community
concerns?
How do you inform community members of important
matters that affect them?
How will you make the Achievement Track Annual
Performance Report available to the public?
Website
Newspaper
Open Houses
Other
Pay W
Application for the National Environmental Achievement Track
OMB No. 2010-0032
-------
Are there any ongoing citizen suits against your facility? Yes
No
S> List references below.
Representative of
a Community/
Citizen Group
State/Local regulator
Other community/local
reference
Organization Nome Phone number
Application for the National Environmental Achievement Track
OMB No. 2010-0032
11
-------
On behalf of
[my facility],
I certify that
I have read and agree to the terms and conditions, as specified in'the National Environmental Achievement
Track Program Description and in the Application Instructions;
I have personally examined and am familiar with the information contained in this Application,
(including, if attached, the Environmental Requirements Checklist).The information contained in
this Application is, to the best of my knowledge and based on reasonable inquiry, true, accurate, and
complete, and I have no reason to believe the facility would not meet all program requirements;
My facility has an environmental management system (EMS), as defined in the Achievement Track
EMS requirements, including systems to maintain compliance with all applicable federal, state, tribal,
and local environmental requirements, in place at the facility, and the EMS will be maintained for the
duration of the facility's participation in the program;
My facility has conducted an objective assessment of its compliance with all federal, state, tribal, and
local environmental requirements, and the facility has corrected all identified instances of potential
or actual noncompliance;
Based on the foregoing compliance assessment and subsequent corrective actions (if any were
necessary), my facility is, to the best of my knowledge and based on reasonable inquiry, currently in
compliance with applicable federal, state, tribal, and local environmental requirements.
I agree that EPA's decision whether to accept participants into or remove them from the National
Environmental Achievement Track is wholly discretionary, and I waive any right that may exist under any law
to challenge EPA's acceptance or removal decision.
I am the senior facility manager and fully authorized to execute this statement on behalf of the corporation
or other legal entity whose facility is applying to this program.
Signature/Date
Printed Name/Title
Facility Name
Facility Street Address
Facility ID Numbers
Page 12
Application for the National Environmental Achievement Track
OMB No. 2010-0032
-------
The National Environmental Performance Track is a U.S. Environmental
Protection Agency program. Please direct inquiries to 1-888-339-PTRK
(7875) or e-mail ptrack@indecon.com. Mail completed applications to:
The Performance Track Information Center
c/o Industrial Economics Incorporated
2067 Massachusetts Avenue
Cambridge, MA 02140
-------
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