National
Environmental
PerformanceTrack
U.S. Environmental Protection Agency
Performance Track
Application
i-r
₯ i
www.epa.gov/performancetrack
888-339-PTRK (888-339-7875)
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Table of Contents
CompletingYour Application: Background Information. 2-3
Completing Your Application: Section-by-Section Instructions. 4-27
Cover. 4-5
Section A.. General Facility Information. 6-7
Section^. Environmental Management System 8-15
Section C. Environmental Performance Commitments 16-23
Section D. Public Outreach and Performance Reporting. 24-25
SectionE. Application and Participation Statement. 26-27
Completing Your Application: Final Steps. 28
Environmental Performance Table. 29-31
Environmental Requirements Checklist. 32-38
Application Form Appendix
fen
Legend
We use the following symbols throughout the instructions.
Benefits ID Websites LjJ Definitions
f >O-B-Q-=\ '
Important ^^= References "SHUT Phone numbers
*
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The Program Guide
is available at
www.epa.govl
performoncetrock
For questions about
the application
process, call
1-888-339-PTRK
(7875).
I. What does filling out the National Environmental
Performance Track Application form involve?
The National Environmental Performance 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 qualifies
" for the Performance 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 criteria as
established in the National Performance Track Program Guide. The
Program Guide is currently available through the EPA Performance
Track website, www.epa.gov/performancetrack, or from the
Performance Track Information Center, toll-free at I -888-339-
PTRK (7875), or via e-mail 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 Performance 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. It
recognizes facilities that consistently meet their legal requirements
and have implemented substantial environmental management
systems. It also encourages facilities to achieve more by
continuously improving their environmental performance and
informing and involving the public.
4. What benefits do I get for joining the National
Environmental Performance Track?
Participants receive several benefits when they enter the
Performance 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 Performance 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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If you are submitting an
application for multiple
o facilities in one
corporation, you must
call I -888-33 9-PTRK.
Facility name
Provide the name of the facility applying for admission. If you are
submitting an application for multiple facilities in one
corporation, you must call 1-888-339-PTR.K.
Name of parent company (if any)
List 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 Performance Track Program.
Name
List the name of the individual who may be contacted for
additional information about your facility's application.
Title
List the title of the contact person.
Phone
List the telephone number of the contact person (including area
code).
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National Environmental Performance Track
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Fax
List the fax number for the contact person (including area code)
E-mail
List the e-mail address (if any) for the contact person.
Facility/Company Website
List the facility/company website address.
Page 5
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The NAICS is a new
classification that is
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/
regulations/siccodes.
If you checked "Yes" in
question 3 and have
fewer than 50
employees at your
facility, then you are
considered a "small
facility" by the
Performance Track.
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.
2. List the North American Industrial Classification System
(NAICS) codes that you use to classify business at your
facility.
If your facility has more than one 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
Administration definition of a small business for your
sector?
Check yes or no. For the 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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National Environmental Performance Track
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5. Complete the Environmental Requirements Checklist in
the back of the instructions and enclose it with your
application.
We've provided an Environmental Requirements Checklist on pages
32-38 of these 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. Complete the Checklist and enclose it with
your application.
6. Optional: Is there anything else you would like to tell us
about your facility? Do you participate in other voluntary
programs at the local, tribal, State, or Federal level?
This question is optional. Use this space 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
32-38 of these
Instructions.
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You must be able to
answer "Yes" to
questions I-I I in
Section 6 in order to
qualify for the
Performance Track.
8
If your EMS has been
certified to ISO 14001,
you may skip this
checklist.
In this section tell us about the environmental management system
(EMS) that your facility has in place. We need to know about your
EMS because it represents your facility's systematic efforts to meet
environmental requirements and improve environmental
performance. You must be able to answer "yes" to questions I -11 in
order to qualify for Performance Track.
An EMS includes, but also goes beyond, managing for compliance with
regulations. An EMS includes an analysis of aspects, which are those
parts of a facility's activities, products, or services that can have an
environmental impact. Aspects include both regulated and
unregulated activities and impacts. An EMS should use a consistent,
objective method for determining which of the aspects are "signifi-
cant." This method may consider environmental risk, regulatory
requirements, community concerns, opportunities for pollution
prevention, and other factors. An EMS should include measurable
objectives and targets for maintaining compliance with environmental
requirements, for reducing risk from significant environmental aspects,
and for advancing other priorities contained in your facility's
environmental policy.
Because we believe that your EMS is critical to maintaining and
improving your environmental performance, we strongly recommend
that you fill out this worksheet about your EMS before answering
Questions I - 5 on page 4 of the Application.
If your EMS has been certified to ISO 14001, you may skip this
checklist.
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EMS Worksheet
I. Environmental policy
LJ Yes LJ No
Does your EMS include a written environmental
policy that has been defined by top facility
management?
[ I Yes i 1 No Does your policy commit your facility to
compliance with both your legal requirements and
your voluntary commitments?
OR
Do you have programs and procedures in place
that achieve compliance with both your legal
requirements and your voluntary commitments?
\
f~] Yes [~1 No Does your policy commit your facility to preventing
pollution at its source wherever possible?
1 Yes
i:
No Does your policy commit your facility to continuously
improve your environmental performance, even in
areas where you do not have regulatory
requirements?
No Does your policy commit your facility to sharing
information with your community about your
environmental performance and about how your EMS
operates?
OR
Do you have programs and procedures in place that
implement your commitment to share information
with your community about your environmental
performance?
If you checked "Yes" to all of the questions in this section, then check
"Yes" to question I on page 4 of the application. Otherwise, check "No."
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2. Planning
[_ J
Have you conducted an analysis of all your facility's
aspects, both regulated and unregulated?
! | Yes [^ j No Have you determined which aspects are significant?
"] Yes ' j No Does your EMS include an inventory of all your legal
requirements at the Federal, State, tribal, or local
level?
, J Yes [ J No Does your EMS include procedures for integrating
changes to your legal requirements or voluntary
commitments into the EMS?
F ] Yes f j No Does your EMS include measurable objectives and
targets and active, documented programs to meet
your policy commitments?
If you checked "Yes" to all of the questions in this section, then check
"Yes" to question 2 on page 4 of the application. Otherwise, check
"No."
3. Implementation and Operation
F^ Yes ' " No Is there top management commitment to your EMS
(e.g. a top manager with responsibility and authority
for implementing your EMS)?
Yes rj No Does your EMS establish roles and responsibilities for
meeting the objectives and targets of the EMS,
including compliance with legal requirements?
Page 10
] Yes f ! No Does your EMS establish procedures for achieving
and maintaining compliance with legal requirements
and meeting performance objectives?
No Does your EMS establish procedures for
communicating EMS information throughout your
organization, including information about your facility's
environmental performance?
[ ~1 Yes r'
~"
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KK?"
Yes
--: Yes
i£?Yes
>5 Yes
No Does your EMS hold managers and employees
accountable for meeting EMS requirements?
l No Does your EMS establish procedures for controlling
EMS documents that include who will maintain the
documents and where they will be stored?
No Does your EMS include a general environmental
training program for all employees?
No Does your EMS include specific training for those who
have direct responsibility for achieving legal
compliance or the objectives and targets in the EMS?
:;i 4 Yes ||f| No Does your EMS document all of the following:
, your environmental policy?
your significant environmental impacts?
* your objectives and targets?
the manager in charge of the EMS?
J your compliance audit program?
, your EMS audit program?
, overall authority for the EMS?
;">;/ Yes Kg No Does your EMS include operation and maintenance
programs for equipment and other activities that are
related to legal compliance and achieving the
objectives and targets in the EMS?
Yes No Does your EMS include an emergency-
preparedness program?
If you checked "Yes" to all of the questions in this section, then check
"Yes" to question 3 on page 4 of the application. Otherwise, check
"No."
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If you answered "No"
to any of the questions
1-5, your EMS may not
meet Performance
Track criteria. Please
call 1-888-3 3 9-PTRK
(7875) for more
information.
4. Checking and Corrective Action
LZ3 Yes CU NO Does your EMS include an ongoing program for
assessing facility performance and for preventing and
detecting nonconformance with your EMS?
] Yes 1 No Do you have an EMS audit program?
{HI Yes EH No Does vour EMS include an ongoing program for
preventing and detecting noncompliance with legal
requirements?
I"! Yes ( 1 No Does your EMS include a compliance audit
U. ,-J *.*._.. J
program?
r~] Yes ["I No Does your EMS include an active program for prompt
corrective action of noncompliance with legal
requirements and of nonconformance with EMS
requirements?
If you checked "Yes" to all of the questions in this section, then check
"Yes" to question 4 on page 4 of the application. Otherwise, check
"No."
5. Management Review
If you have a documented management review of the performance and
the effectiveness of your EMS in meeting the EMS policy commitments,
then check "Yes" to question 5 on page 4 of the application.
Otherwise, check "No."
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National Environmental Performance Track
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Have you done a comprehensive review of all activities
conducted at your facility that could impact the
environment? (i.e. have you done an aspect analysis?)
An aspect is any part of a facility's activities, products, or services
that could have an impact on the environment. An aspect analysis
includes both regulated and unregulated activities and products
and their associated impacts. If you have done a complete
inventory of all your facility's operations and determined the
activities that could have an impact on the environment, check
"Yes" to this question. Otherwise, check "No."
Examples of activities and aspects are:
Activity
Degreasing
Painting & Coating
Employee Commuting
Office HVAC Use
7.
Aspect(s)
Hazardous material use (toxic
solvents)
Emissions of VOCs, Emissions of
air toxics
Emissions of greenhouse gases,
VOCs, NOx
Energy use
Have you classified your aspects based on their potential
harm to the environment, on community concerns, and/or
on other objective factors? (i.e. have you determined your
significant aspects?)
Some of your aspects should be classified as "significant" because
they have the greatest potential to cause a significant
environmental impact. Your EMS should include a consistent
method for determining which of the aspects are significant. In
addition to environmental risk, this method may consider other
factors such as regulatory requirements, community concerns, or
opportunities for pollution prevention. If you have identified and
documented your significant environmental aspects, check "Yes."
Otherwise, xheck "No."
8. When did you last update your aspect analysis? (mo/yr)
As part of your EMS implementation cycle, your aspect analysis
should be reviewed and updated to insure that it continues to
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accurately reflect your facility's activities. Please list the
date (mo/yr) that you last updated your aspect analysis.
9. Have you completed at least one EMS cycle (plan-
do-check-act)?
A complete cycle includes:
Defining and documenting your EMS;
Identifying significant aspects and legal requirements;
Setting measurable objectives and targets;
Establishing roles and responsibilities for meeting EMS
and legal requirements;
Conducting training for personnel on EMS and legal
requirements;
Taking steps to meet the established objectives
and targets;
Evaluating your progress in meeting the established
objectives and targets;
Conducting an EMS audit;
Completing a compliance audit;
Correcting any areas of EMS non-compliance or legal
non-compliance; and
Completing a management review of the EMS and its
results.
If you have completed all of these activities, check "Yes." If
not, check "No."
10. 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. (These audits may have been
performed by someone in your facility or parent company or by
an independent auditor. This question does not refer to inspec-
tions by government agencies). Otherwise, check "No."
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11. 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 third-party assessment, indicate the protocol you
used by checking one of the boxes under "Third-party
assessment."
ISO 14001 Certification- International Standards Organization
14001 Certification (www.iso.org)
Other- Please fill in the blank with the method you used.
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
(es.epa.gov/oeca/cemp/cemptoc.html)
Other- Please fill in the blank with the method you used.
Useful websites:
www.gemi.org
es.epa.gov/oecal
cemp/cemptoc.html
www.iso.org
Page 7J
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WOB
See the
Environmental
Performance Table
on pages 29-31 of
the Instructions.
In the Environmental
Performance Table, we
use the terms category
and aspect
Categories ore
genera/ types of
environmental
impacts.
Aspects are
more specific
impacts.
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 the National
Environmental
Performance Track
Program Guide,
Section HA 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 your past achievements and future improvements, you
will need to refer to the Environmental Performance Table (on pages 29-
31 of the Instructions).
The Environmental Performance Table includes a broad range of
environmental impacts. Not all of these environmental 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 units in the right-hand column.
In the Table, we've given you units that you must use .to capture
performance on an aspect. When you report on your performance,
please state units with all quantities.
It is important to remember that some 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, you will select a minimum of
two environmental aspects from any of the categories in the
Environmental Performance Table (on pages 29-31 of the Instructions).
Then, fill out the table on pages 5 and 6 to report performance on those
aspects. If you are a small facility, you can choose to complete only the
table for the first aspect.
To commit to future improvements, you will select at least four
environmental aspects (2 for small facilities) from any of the
categories in the Environmental Performance Table (on pages 29-31 of
the Instructions). You must commit to specific improvements over the
next three years. The commitments you identify must go beyond any
actions that you already take to comply with existing legal requirements
at the Federal, State, tribal, or local levels. No more than 2 of your
environmental aspects can be from the same environmental category.
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National Environmental Performance Track
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Past Achievements Table
You must report past achievements for at least two
environmental aspects, and you must choose these aspects
from the Environmental Performance Table on pages 29-31 of
these Instructions. Please quantify each of your aspects using the
units listed for that aspect in the Environmental Performance Table.
First achievement
I. What aspect have you selected from the Table on page 29-
31?
Use the Environmental Performance Table on pages 29-31 of these
Instructions to choose your first aspect. Write the name of that
aspect (e.g., energy use) in the Table.
2. What units are you using to quantify this aspect? (See
Table on page 29-31.)
Refer to the Environmental Performance Table on pages 29-31 of
these Instructions to choose the units that you are going to use to
quantify your past achievements. For any aspect you choose, you
must use the units we've provided in the Table.
3. List the past annual quantity of the aspect (from two
years ago), and the current annual quantity of the aspect
(from the most recent year for which you have data).
For the "Past" annual quantity, please give us an annual
measurement of the aspect from two years ago. For the
"Current" quantity, give us an annual measurement of the aspect
from the most recent calendar year for which you have data.
4. What are the years for which you are reporting these
quantities?
List the calendar years during which you measured the "Past"
annual quantity of the aspect and the "Current" annual quantity of
the aspect.
\
If you qualify as a
small facility, you need
to report past
achievements 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 Business
Administration
definition of a small
bus/ness for your
sector.
For any aspect you
choose, you must use
the units we've
provided in the Table.
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5. Estimate your past normalizing factor.
We're asking for a normalizing factor so that we can determine
improvements in eco-efficiency (environmental impact relative to
economic activity) as well as absolute reductions. This allows us to
report total reductions from all Performance Track facilities and also
to show that, in many cases, Performance Track facilities have achieved
these reductions at the same time they have increased the scale of
their operations.
In most cases, production level is the best normalizing factor.
However, in some cases, employment might be a better normalizing
factor: e.g., if your aspect is reduction in greenhouse gases from a
carpooling program.
If you are using production as a normalizing factor, the factor will be
the ratio of production in the past to production fn the most recent
year for which you have aspect data. If you are using aspect data for
the calendar years 1998 and 2000, your past normalizing factor would
be:
Production level in 1998
Production level in 2000
For example,
54.000 cars produced in 1998
60,000 cars produced in 2000
= 0.9= normalizing factor for 1998
Page 18
6. What is your normalizing factor based on (e.g., production,
employment)?
Your normalizing factor is the type of activity that you quantified in
the numerator and denominator of the fraction that
determined your normalizing factor. The normalizing factor in the
example for Question 5 above is "production." If you produce
different kinds of products, you may choose to express production as
a number of units weighted by product complexity or type.
7. You reported an improvement in the quantity of the aspect
in Question 3. How did you achieve this improvement?
We'd like to know how you achieved the improvement you reported
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in Question 3. Information you might include is: process
changes, equipment, product redesigns, shutting off equipment
when not in use, etc.
To complete the Past Achievements sect/on: Fill out the table on
page 6 of the application for the second aspect unless you are a
small facility. If you are a small facility, you need to report past
achievements for only one aspect. You can report on additional
past achievements by copying page 6 and attaching the extra sheets
to your completed application.
Example of a completed Past Achievements Table
First achievement
J What aspect have you selected from
the Table on page 29-3 1 ?
2 What units are you using to
quantify this aspect?
jf List the past annual quantity of the
aspect (from two years ago) and the
current annual quantity of the aspect
(from the most recent year for which
you have data).
4 What are the years for which you are
reporting these quantities?
r Estimate your past normalizing factor.
(Page 1 8 of the Instructions will help
you calculate this)
fa What is your normalizing factor based
on (e.g., production, employment.)?
7 You reported an improvement in the
quantity of the aspect in Question 3.
How did you achieve this
improvement?
Energy Use
mmBtu
PAST
1,112,400 mmBtu
1998
0.9
CURRENT
960,OOOmmBtu
2000
1.0
Production
Powered down lighting, HVAC, and production
equipment; repaired compressed air leaks.
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See the
Enwronmento/
Performance Table
on page 29-31 of
these Instructions.
If you're not sure
how your objectives
and targets fit into
our aspects or
whether your
aspects ore
significant, call the
PTrack Information
Hotline at 1-888-
339-PTRK.
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.
Future Commitments Table
You must make future commitments for at least four
environmental aspects, and you must choose these aspects
from the Environmental Performance Table on pages 29-31 of
these Instructions. The aspects you select for your future
commitments should be related to the objectives and targets in your
EMS. Where possible, they should also be identified as having a
significant environmental impact in your EMS.
First aspect you've selected
I. What aspect have you selected from the Table on pages
29-31?
Use the Environmental Performance Table on pages 29-31 of these
Instructions to choose your first aspect. Write the name of that
aspect (for example, energy use) in the table.
2. What units are you using to quantify this aspect?
Refer to the Environmental Performance Table on pages 29-31 of
the Instructions to choose the units that you are going to use to
quantify your past achievements. For any aspect you choose, you
must use the units we've provided in the Table.
3a. Is this aspect significant in your EMS?
Tell us if this aspect is considered significant in your EMS.
3b. If ho, please explain why you believe this aspect should be
included as a performance commitment.
If the aspect is not considered significant in your EMS, we'd like to
know why you have chosen to include it as a performance
commitment.
4. List the current annual quantity of the aspect and the
quantity you are committing to achieve by the end of
your third year in Performance Track.
For the "Current" quantity, give us an annual measurement of the
aspect from the most recent calendar year for which you have
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data. For the "Future" annual quantity, please give us the amount
that you are committed to achieve by the end of the third year of
your participation in Performance Track.
5. What are the years for which you are reporting these
quantities (mo/yr to mo/yr)?
List the calendar years during which you measured the "Current"
annual quantity of the aspect. Under "Future" list the calendar year
that corresponds to the third year of your participation in
Performance Track. For example, if you apply in the fall of 2002 and
are accepted in January, 2003, then your third year of participation
will be 2005. If you apply in the spring of 2003 and are accepted in
July, 2003, then your third year of participation will be 2005.
6a. (Optional) Estimate your future normalizing factor.
We will assume that your performance commitments are based on
a constant production or employment level. If you would like to
base your commitment on changing production or employment,
please fill out optional questions 6a, b.
In most cases, production level is the best normalizing factor.
However, in some cases, employment might be a better normalizing
factor: e.g., if your aspect is reduction in greenhouse gases from a
carpooling program.
If you are using production as a normalizing factor, the factor will be
the ratio of estimated production in the future to actual production
in the most recent year for which you have aspect data. If your
commitment will be met in 2005 and your most recent data is
available for 2001, your future normalizing factor would be:
estimated production level in 2005
production level in 2001
For example,
1.2 million yards of carpet to be produced in 2005 = 1-2
I million yards of carpet to be produced in 2001 = normalizing
factor for 2004
Page 21
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6b. (Optional) What is your normalizing factor based on?
Your normalizing factor is the type of activity you quantified in the
numerator and denominator of the fraction that determined your
normalizing factor. The normalizing factor in the example for
Question 6 above is production.
7. You commited to an improvement in the quantity of this
aspect in Question A. How do you plan to achieve this
improvement?
How do you plan to achieve the improvement stated in Question 4.
You might include information like: process changes, equipment
upgrades, product redesign, shutting off equipment while not in use,
etc.
8a. Are you subject to Federal, State, tribal, or local regulatory
requirements for this aspect?
Check "Yes" if you are subject to Federal, State, tribal, or local
regulatory requirements for this aspect. Check "Yes" if
requirements have been established and will apply to you in the
future. Otherwise, check "No."
8b. If "Yes," please list those requirements, including the
quantitative limits and compliance deadlines that apply to
you. Explain how your commitment exceeds requirements.
If you are subject to any requirements, we'd like for you to list
those in the space provided. Tell us how you will exceed those
requirements.
To complete the Future Commitments sect/on: Fill out the tables on
pages 8-10 of the application for the second, third, and fourth aspect. If
you are a small facility, you need to complete only the tables for the first
and second aspect. You can make additional commitments by copying
page 7 and attaching the extra sheets to your completed application.
Page 22
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Example of a completed Future Commitments Table
First commitment
jf What aspect have you selected from
the Table on pages 29-3 1 ?
2 What units are you using to
quantify this aspect?
J^ Is this aspect considered significant in
your EMS?
j£j If no, please explain why you believe
this aspect should be included as a
performance commitment.
/
4 List the current annual quantity of the
aspect and the annual quantity you are
committing to.
r What are the years for which you are
reporting these quantities?
fa (Optional) Estimate your future
normalizing factor, (page 2 1 of the
instructions will help you calculate
this.)
fifo (Optional) What is your normalizing
factor based on (e.g., production,
employment)?
7 You committed to an improvement
in the quantity of this aspect in
Question 4. How do you plan to
achieve this improvement?
Sa Are you subject to Federal, State,
tribal, or local regulatory
requirements for this aspect?
8b If yes, please list those requirements,
including the quantitative limits that
apply to you. Explain how your
commitment exceeds requirements.
Water use
gallons
Xs Yes No
1
CURRENT FUTURE
4. 84 million gallons 4. 70 million gallons*
2001 2005
i.o 1.2
production
Optimize dyeing process, find opportunities to
reuse cooling water, assess water use efficiency
of future investments in yard dyeing.
Yes X No
Page 2}
-------
See the National
Environmental
Performance Track
Program Guide,
Section A, "Public
Outreach and
Performance
Reporting" for a full
description of program
criteria.
Page 24
In this section, tell us about your commitment to public outreach.
I. How do you identify and respond to community
concerns?
r
Briefly describe how you identify and respond to community
concerns. (For example, "We hold an open house every six
months to discuss issues with the community," or "We have an
employee who takes calls from community members.")
2. How do you inform community members of important
matters that affect them?
Briefly describe 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 Performance 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 related to
environmental issues against your facility?
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, check "Yes" and
briefly describe their current status. Otherwise, check "No."
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. Please list at least
one contact in each of the categories.
-------
National Environmental Performance Track
www.epa.gov/performancetrack
l-888-339-PTRK(7875)
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/ triball 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/local reference (e.g., emergency
management official or business associate).
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.
Page 25
-------
See the National
Environmental
Performance Track
Program Description,
Section A, "Public
Outreach and
Performance
Reporting" for a full
description of program
criteria.
To be able to sign the
Participant Statement,
you must meet certain
criteria 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 criteria 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 Performance 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
accurately execute the certification;
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.
Page 26
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National Environmental Performance Track
www. epa.gov/performancetrack
l-888-339-PTRK(7875)
Screening Criteria
Please use the following criteria to judge whether your facility is eligible
to participate in the National Environmental Performance Track. Your
facility should not participate if a compliance screen shows any of the
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
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/
performancetrackl
compliance
Page 2 7
-------
pi For questions about
the application
process, call
1-888-339-PTRK
(7875).
Page 28
I. How do I know if my application is complete?
A complete application for the Performance Track Program
consists of a fully completed Application Form and a signed
Performance Track Program Application and Participation Statement.
2. How do I submit my application?
To submit your application:
I) E-mail the completed application to ptrack@indecon.com,
and
2) Fax the completed and signed Section E (not the entire
application) to (617) 354-0463.
If you cannot e-mail the application, mail a hard copy of the entire
completed application 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?
Through the appropriate regional office, EPA will consult with the
State where your facility is located to help determine whether your
facility qualifies for Performance Track.
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. <
-------
You will use the Environmental Performance Table to choose the aspects for which you will report past
achievements and future commitments on pages 5-10 of the Application.
\ .
The Environmental Performance Table includes a broad range of environmental impact, but not all of
these impacts will be relevant to your facility. In the Table, we use the terms category and aspect to
classify these environmental impacts:
Categories are general types of environmental impacts.
Aspects are more specific impacts that can be quantified by the units in the right-
hand column.
The units that we've given in the table are some common examples of quantities that can capture
performance on specific aspects. You must use the units we've provided on your Performance
Track Application. We need standard measures to report on the progress of Performance Track
participants as a group. When you report on your performance in the application, please state your
units with all quantities.
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 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 following acronyms are used in the Environmental Performance Table:
BOD = Biological Oxygen Demand
COD = Chemical Oxygen Demand
Btu = British Thermal Units
kWh = Kilowatt Hours
mmBtu= Million Metric British Thermal Units
ppm = Parts per million
NOx = Nitrous Oxides
VOC = Volatile Organic Compounds
CGU = Colony Forming Unit
MPN = Most Probable Number
dBA = decibels adjusted to measure human response to sound
Page 29
-------
mi'
Category
Energy Use
Water Use
Materials Use
Air Emissions
(including motor
vehicle emissions)
Waste
Preservation/Restoration
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
Emissions of Sulfur Dioxide
Emissions of Paniculate Matter
Emissions of Carbon Monoxide
Emissions ofToxics
Total Solid Waste
Hazardous Solid Waste
Removal
Remediation
Habitat Impacts
Units
Btu, mmBtu, KwH, MwH
gallons
tons, Ibs
tons, Ibs
tons, Ibs
tons, Ibs
tons, Ibs
tons, Ibs
tons, Ibs
tons, Ibs
tons, Ibs
tons, Ibs
tons, Ibs
tons, Ibs
tons, Ibs
tons, Ibs
acres, sq ft
acres, sq ft
Page 30
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Category
Discharges to Water
Accidental Releases
Product Performance
Other
Aspect
COD Discharges to Water
BOD Discharges to Water
Discharges of Toxics to Water
Discharges of Total Suspended
Solids to Water
Discharges of Nutrients to
Water
Sediment from Runoff
Discharges of Pathogens
to Water
Release History
Vulnerability and
Potential for Releases
Expected Lifetime Energy Use
of Product
Expected Waste (to Air, Water,
Land) of Product
Packaging Materials Used in
Product
Waste to Air, Water, Land from
Disposal or Recovery of
Product
Noise
Odor
Units
tons, Ibs
tons, Ibs
tons, Ibs
tons, Ibs
tons, Ibs
tons, Ibs
MPN/g, MPN/ml, CFU/g,
CFU/ml
Ibs, tons, or gallons;
number of releases
sq ft, acres (size of
vulnerable zone), Ibs,
tons, or gallons
Btu, mmBtu, KwH, MwH
ton, Ibs
tons, Ibs
tons, Ibs
dBA, duration of events
(with noise levels
exceeding established
thresholds)
applicant's discretion
Page 31
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Use the Environmental Requirements Checklist to answer Question 5 in Sect/on 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)
Q 2. Permits and Registration of Air Pollution Sources
Q 3. General Emission Standards, Prohibitions, and Restrictions
Q 4. Control of Incinerators .
Q] 5. Process Industry Emission Standards
Q 6. Control of Fuel Burning Equipment
P 7. Control of VOCs
Q 8. Sampling, Testing, and Reporting
Q 9. Visible Emissions Standards
| | 10. Control of Fugitive Dust
Q II. Toxic Air Pollutants Control
Q 12. Vehicle Emissions Inspections and Testing
Other (you must list these if applicable)
n 13. Other Federal, State, tribal, or local regulations not listed above.
14. ID Numbers (specify whether State or Federal).
Page 32
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Hazardous Waste Management Regulations
Check all that apply.
G I Identification and listing of hazardous waste (40 CFR 261)
G -Characteristic waste
G -Listed waste
G 2. Standards Applicable to Generators of Hazardous Waste (40 CFR 262)
G -Manifesting
G -Pre-transport requirements
G -Record-keeping/Repotting
G 3. Standards Applicable to Transporters of Hazardous Waste (40 CFR 263)
G -Transfer facility requirements
G -Manifest system and record-keeping
G -Hazardous waste discharges
G 4. Standards for Owners and Operators of TSD Facilities (40 CFR 264)
G -General facility standards
G -Preparedness and prevention
G -Contingency plan and emergency procedures
G -Manifest system, record-keeping, and reporting
G -Groundwater protection
G -Financial requirements
G -Use and management of containers
G -Tanks
G -Waste piles
G -Land treatment
G -Incinerators
G 5. Interim Standards for TSD Owners and Operators (40 CFR 265)
Q 6. Interim Standards for Owners and Operators of New Hazardous Waste Land
Disposal Facilities (40 CFR 267)
G 7. Administered Permit Program (Part B) (40 CFR 270)
Other (you must list these if applicable)
G 8. Other Federal, State, tribal, or local regulations not listed above.
Page 33
-------
9. ID Numbers (specify whether State or Federal).
Hazardous Materials Management
Check all that apply.
Q I. 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)
Q] 3. Hazardous Materials Transportation Regulations (49 CFR 172-173)
n 4. Worker Right-to-Know Regulations (29 CFR 1910.1200)
Q 5. Community Right-to-Know Regulations (40 CFR 350-372)
Q 6. Underground Storage Tank Regulations (40 CFR 280-282)
Other (you must list these if applicable)
Q 7. Other Federal, State, tribal, or local Regulations not listed above.
8. ID Numbers (specify whether State or Federal).
Solid Waste Management
Check all that apply.
Q I. Criteria for Classification of Solid Waste Disposal Facilities and Practices
(40 CFR 257)
Ql 2. Permit Requirements for Solid Waste Disposal Facilities
[^] 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 fot these if applicable)
Q 6. Other Federal, State, tribal, or local regulations not listed above.
Page 34
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7. ID Numbers (specify whether State or Federal).
Water Pollution Control Requirements
Check all that apply.
n I O'1 Spill Prevention Control and Countermeasures (SPCC) (40 CFR 11.2)
Q 2. Designation of Hazardous Substances (40 CFR 116)
Q] 3. Determination of Reportable Quantities for Hazardous Substances (40 CFR 117)
n 4. NPDES Permit Requirements (40 CFR 122)
G 5. Toxic Pollutant Effluent Standards (40 CFR 129)
Q| 6. General Pretreatment Regulations for Existing and New Sources (40 CFR 403)
Name of POTW
ID # of POTW
[H| 7. Organic Chemicals Manufacturing Point Source Effluent Guidelines and Standards
(40 CFR 414)
Q] 8. Inorganic Chemicals Manufacturing Point Source Effluent Guidelines and
Standards (40 CFR 415)
[[] 9. Plastics and Synthetics Point Source Effluent Guidelines and Standards
(40 CFR 416)
G 10. Water Quality Standards
Q II. Effluent Limitations for Direct Dischargers
Q 12. Permit Monitoring/Reporting Requirements
G 13. Classifications and Certifications of Operators and Superintendents of Industrial
Wastewater Plants
n 14. Collection, Handling, and Processing of Sewage Sludge
G 15. Oil Discharge Containment, Control, and Cleanup
n 16. Standards Applicable to Indirect Discharges (Pretreatment)
Other (you must list these if applicable)
D 17. Other Federal, State, tribal, or local regulations not listed above.
18. ID Numbers (specify whether State or Federal).
Page 3)
-------
Drinking Water Regulations
Check all that apply.
G I. Underground Injection and Control Regulations, Criteria, and Standards (40 CFR
144, 146)
G 2. National Primary Drinking Water Standards (40 CFR 141)
G 3. Community Water Systems Monitoring and Reporting Requirements (40 CFR 141)
G 4. Permit Requirements for Appropriation/Use of Water from Surface or Subsurface
Sources
G 5: Underground Injection Control Requirements
G 6. Monitoring, Reporting, and Record-keeping Requirements for Community Water
Systems
Other (you must list these if applicable)
G 7. Other Federal, State, tribal, or local regulations not listed above.
G 8. ID Numbers (specify whether State or Federal).
Toxic Substances
Check all that apply.
G I Manufacture and Import of Chemicals, Record-keeping, and Reporting
Requirements (40 CFR 704)
G 2. Import and Export of Chemicals (40 CFR 707)
G 3. Chemical Substances Inventory Reporting Requirements (40 CFR 710)
G 4. Chemical Information Rules (40 CFR 712)
G 5. Health and Safety Data Reporting (40 CFR 716)
G 6. Pre-manufacture Notifications (40 CFR 720)
G 7. PCB Distribution Use, Storage, and Disposal (40 CFR 761)
G 8. Regulations on Use of Fully Halogenated Chlorofluoroalkanes (40 CFR 762)
G 9. Storage and Disposal of Waste Material Containing TCDD (40 CFR 775)
Other (you must list these if applicable)
G 10- Other Federal, State, tribal, or local regulations not listed above.
Page 36
-------
11. ID Numbers (specify whether State or Federal).
Pesticide Regulations
Check all that apply.
n I- FIFRA Pesticide Use Classification (40 CFR 162)
Q 2. Procedures for Storage and Disposal of Pesticides and Containers (40 CFR 165)
G 3. Certification of Pesticide Applications (40 CFR 171)
n 4. Pesticide Licensing Requirements
Q] 5. Labeling of Pesticides
Q 6. Pesticide Sales, Permits, Records, Application, and Disposal Requirements
fj 7. Disposal of Pesticide Containers
Q 8. Restricted Use and Prohibited Pesticides
Other (you must list these if applicable)
fj 9. Other Federal, State, tribal, or local regulations not listed above.
10. ID Numbers (specify whether State or Federal).
Environmental Clean-up, Restoration, and Corrective Action
G I. Comprehensive Environmental Response, Compensation, and Liability Act
(CERCLA or Superfund). Please identify and include date of Record of Decision.
2- RCRA Corrective Action. Please provide date of RCRA/HSWA permits that
require corrective action.
Page 37
-------
. , ' <-,",. "
O 3. Other Federal, State, tribal, or local environmental clean-up, restoration,
corrective action regulations not listed above. Please include date of
requirement.
Facility name:
Facility location:
Page 38
-------
OMB No. 2010-0032
Expiration Date: 06/30/03
National
Environmental
PerformanceTrack
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 Performance Track Program.
Name Mr./Mrs./Ms./Dr.
Title
Phone
Fax ___
E-mail
Facility/Company Website
*lf you are applying for multiple facilities, you must call I-888-339-PTRK (7875).
-------
I Why do we need this information?
1 EPA needs background information on your facility to
i evaluate your application.
j
' 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?
OMB No. 2010-0032
Expiration Date: 06/30/03
2 List the North American Industrial Classification System NAICS
(NAICS) codes that you use to classify business at your
facility.
2 Does your company meet the Small Business f _j
Administration definition of a small business for your
sector?
Yes
"I No
A How many employees (full-time equivalents) currently
work at your facility? If you checked "Yes" in question 3
and have fewer than 50 employees at your facility, then
you are considered a "small facility" by the Performance
Track program.
' } Fewer than 50
r j 50-99
I0°-499
Qj 500-1,000
More than 1,000
Complete the Environmental Requirements Checklist on
pages 32-38 of the instructions and enclose it with your
application.
Page 2
Applicationfor the NationalEnvimnmental Performance Track
-------
OMB No. 2010-0032
Expiration Date: 06/30/03
-
Optional: Is there anything else you would like to tell us
about your facility? Do you participate in other
voluntary programs at the local, tribal, State, or Federal
level?
Application for theNationalEnvirvnmental Performance Track
Page 3
-------
OMB No. 2010-0032
Expiration Date: 06/30/03
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 Performance
Track requirements.
Tell us if you have completed a sjelf-assessment or
have had a third-party assessment of your EMS.
Read the EMS requirements on page 9-12 of instructions.Tell us
if your EMS meets these requirements for:
J
2
3
4
L.IIVII UllllltMILdl pUIIL/
Planning
Implementation and operation
Checking and cot \ ective action
^d'iM'^/TArvi^aM*' **es\i\es\t.i
Yes
Yes
Yes
Yes
; No
No
No
Mn
(j Have you done a comprehensive review of all activities
conducted at your facility that could impact the
environment? (i.e., have you done an aspect analysis?)
j Have you classified your aspects based on their potential
harm to the environment, on community concerns,
and/or on other objective factors? (i.e., have you
determined your significant aspects?)
§ When did you last update your aspect analysis? (mo/yr)
n Have you completed at least one EMS cycle
(plan-do-check-act)?
fQ Did this cycle include both an EMS and a compliance
audit?
jjlf 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
No
No
Yes
Yes
Yes
Self-assessment
GEMI
CEMP
Other
No
No
No
Third-party assessment
f ISO 14001 Certification
,,.'.. Other
Application for the National Environmental Performance Track
-------
OMBNo. 2010-0032
Expiration Date: 06/30/03
Why do we need this information?
Facilities need to show that they are committed to
improving their environmental performance.This means
describing past achievements and making future
commitments.
What do you need to do?
Refer to the Environmental Performance Table in the Instructions to
answer Parts I and 2.
Part You must report past achievements for at least two environmental aspects, and you must
7 choose these aspects from the Environmental Performance Table on pages 29-31 of the
Instructions. Please quantify each of your aspects using the units listed for that aspect in the Environmental
Performance Table. If you have questions about listing your past achievements under the aspects given, call the
PTrack Information Hotline at 1-888-339-PTRK.
Note to small facilities: If you are a small facility, you must report past achievements for only one
environmental aspect.
First achievement
What aspect have you selected from
the Table on page 29-31 ?.
What units are you using to quantify
this aspect? (See Table, page 29-31.)
PAST
CURRENT
List the past annual quantity of the
aspect (from two years ago) and the
current annual quantity of the aspect
(from the most recent year for Which
you have data).
What are the years for which you are
reporting these quantities?
Estimate your past normalizing factor
(Page 18 of the Instructions will help
you calculate this.)
1.0
What is your normalizing factor based
on (e.g., production, employment)?
You reported an improvement in the
quantity of the aspect in Question 3.
How did you achieve this
improvement?
Application for theNationalEnvironmental Performance Track
Page 5
-------
OMB No. 2010-0032
Expiration Date: 06/30/03
Second achievement
What aspect have you selected from
the Table on page 29-31 ?
What units are you using to quantify
this aspect? (See Table, page 29-31.)
PAST
CURRENT
List the past annual quantity of the
aspect (from two years ago) and the
current annual quantity of the aspect
(from the most recent year for which
you have data).
What are the years for which you are
reporting these quantities?
Estimate your past normalizing factor.
(Page 18 of the Instructions will help
you calculate this.)
I.O
What is your normalizing factor based
on (e.g., production, employment)?
You reported an improvement in the
quantity of the aspect in Question 3.
How did you achieve this
improvement?
Part
2
You must make future commitments for at least four environmental aspects, and you must
choose these aspects from the Environmental Performance Table on pages 29-31 of the
Instructions. The aspects you select for your future commitments should be related to the objectives and
targets in your EMS. Where possible, they also should be identified as having a significant environmental
impact in your EMS. No more than two of your aspects can be from the same environmental category. If
you're not sure how your objectives and targets fit into our aspects or whether your aspects are significant,
call the PTrack Information Hotline at I-888-339-PTRK.
Once you have chosen your four environmental aspects, then fill in all the necessary information for these
aspects in the tables on pages 7-10 of this form. Please quantify each of your aspects using the units listed for
that aspect in the Evironmental Performance Table. Each table that you must fill in corresponds to one of the
environmental aspects you have chosen.
We will assume that your performance commitments are based on a constant production or employment
level. If you would like to base your commitment on changing production or employment, please fill out
optional questions 6a and 6b.
Note to small facilities: If you are a small facility, you must report future commitments for only two
environmental aspects.
Page 6
Application for the NationalEnvimnmental Performance Track
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OMB No. 2010-003'2
Expiration Date: 06/30/03
(>
First commitment
j What aspect have you selected from
the Table on pages 29-3 1 ?
2 What units are you using to
quantify this aspect?
J^ Is this aspect considered significant in
your EMS?
Jb If no, please explain why you believe
this aspect should be included as a
performance commitment.
^ List the current annual quantity of the
aspect and the annual quantity you are
committing to achieve by the end of the
third year of your participation in
Performance Track.
c What are the years for which you are
reporting these quantities?
fa (Optional) Estimate your future
normalizing factor. (Page 2 1 of the
Instructions will help you calculate
this.)
(fo (Optional) What is your normalizing
factor based on (e.g., production,
employment)?
7 You committed to an improvement
in the quantity of this aspect in
Question 4. How do you plan to
achieve this improvement?
8a Are you subject to Federal, State,
tribal, or local regulatory
requirements for this aspect?
Sb - If yes, please list those requirements,
including the quantitative limits and
compliance deadlines that apply to
you. Explain how your commitment
exceeds requirements.
'"] Yes [ \ No
CURRENT FUTURE
I.O
'Yes No
Application for theNationalEnvimnmental Performance Track
Page?
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OMBNo. 2010-0032
Expiration Date: 06/30/03
Second commitment
J What aspect have you selected from
the Table on pages 29-3 1 ?
2 What units are you using to
quantify this aspect?
Jg Is this aspect considered significant in
your EMS?
j^y If no, please explain why you believe
this aspect should be included as a
performance commitment.
* List the current annual quantity of the
aspect and the annual quantity you are
committing to achieve by the end of the
third year of your participation in
Performance Track.
s What are the years for which you are
reporting these quantities?
fa (Optional) Estimate your future
normalizing factor. (Page 2 1 of the
Instructions will help you calculate
this.)
^gj (Optional) What is your normalizing
factor based on (e.g., production,
employment)?
7 You committed to an improvement
in the quantity of this aspect in
Question 4. How do you plan to
achieve this improvement?
^ Are you subject to Federal, State,
tribal, or local regulatory
requirements for this aspect?
Sb If yes, please list those requirements,
including the quantitative limits and
compliance deadlines that apply to
you. Explain how your commitment
exceeds requirements.
Yes No
CURRENT FUTURE
I.O
Yes ' No
Application for the NationalEnvim nmental Peifo rmance Track
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OMB No. 2010-0032
Expiration Date: 06/30/03
liftlr W '''»
C, continued
Third commitment
y What aspect have you selected from
the Table on pages 29-3 1?
2 What units are you using to
quantify this aspect?
j^ Is this aspect considered significant in
your EMS?
Jf> If no, please explain why you believe
this aspect should be included as a
performance commitment.
jf List the current annual quantity of the
aspect and the annual quantity you are
committing to achieve by the end of the
third year of your participation in
Performance Track
g What are the years for which you are
reporting these quantities?
^ (Optional) Estimate your future
normalizing factor. (Page 2 1 of the
Instructions will help you calculate
this.)
(fo (Optional) What is your normalizing
factor based on (e.g., production,
employment)?
7 You committed to an improvement
in the quantity of this aspect in
Question 4. How do you plan to
achieve this improvement?
8a Are you subject to Federal, State,
tribal, or local regulatory
requirements for this aspect?
8b If yes, please list those requirements,
including the quantitative limits and
compliance deadlines that apply to
you. Explain how your commitment
exceeds requirements.
x| Yes . ;. No
CURRENT FUTURE
.
I.O
Yes No
KaaesfcS&SSS.'-* ,?».** ;.-.,. .v-...- . . .
AppKcationfortheNationalEnvimnmentalPerformance Track
Page 9
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OMB No. 2010-0032
Expiration Date: 06/30/03
Fourth commitment
^ What aspect have you selected from
the Table on pages 29-3 1 ?
2 What units are you using to
quantify this aspect?
j^ Is this aspect considered significant in
your EMS?
J£; If no, please explain why you believe
this aspect should be included as a
performance commitment.
jr List the current annual quantity of the
aspect and the annual quantity you are
committing to achieve by the end of the
third year of your participation in
Performance Track.
c What are the years for which you are
reporting these quantities?
fa (Optional) Estimate your future
normalizing factor. (Page 2 1 of the
Instructions will help you calculate
this.)
gfo (Optional) What is your normalizing
factor based on (e.g., production,
employment)?
7 You committed to an improvement
in the quantity of this aspect in
Question 4. How do you plan to
achieve this improvement?
8a Are you subject to Federal, State,
tribal, or local regulatory
requirements for this aspect?
Sb If yes. please list those requirements,
including the quantitative limits and
compliance deadlines that apply to
you. Explain how your commitment
exceeds requirements.
r~] Yes LJ N°
CURRENT FUTURE
I.O
-
f "1 Yes r~J No
I _ t i, ^.j!
Page tO
Application for the NationalEnvironmental Performance Track
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OMB No. 2010-0032
Expiration Date: 06/30/03
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.
v List three references who are familiar with your facility.
J How do you identify and respond to community
concerns?
2 How do you inform community members of important
matters that affect them?
How will you make the Performance Track Annual
Performance Report available to the public?
I Website
j Newspaper
i Open Houses
"" Other
Application for the NationalEnvimnmental Performance Track
11
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OMB No. 2010-0032
Expiration Date: 06/30/03
Are there any ongoing citizen suits related to
environmental issues against your facility?
If yes, describe briefly in the right-hand column.
Yes
No
5 List references below.
Organization
Name
Phone number
Representative of
a community!
citizen group
State/tribal/local
regulator
Other community/local
reference
(e.g., emergency
management official or
bus/ness associate)
Page 12
AppKcationfortheNationalEnvinnmental Performance Track
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OMB No. 2010-0032
Expiration Date: 06/30/03
On behalf of
I certify that
[my facility],
I have read and agree to the terms and conditions for Application and Participation in the National
Environmental Performance Track, as specified in the National Environmental Performance Track Program Guide
and in the Application Instructions;
o I have personally examined and am familiar with the information contained, in this Application,
including 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 wpuld not meet all program requirements;
n My facility has an environmental management system (EMS), as defined in the Performance 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;
D 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 Performance 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 Mr.IMrs.IMs.IDr.
Phone Number/E-mail
Facility Name
Facility Street Address
City/State/Zip Code
ApplicationfortheNationalEnvimnmentalPerformance. Track
Page 13
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OMB No. 2010-0032
Expiration Date: 06/30/03
The National Environmental Performance Track is a U,S. Environmental Frot^tjop
Please direct inquiries to l-888r339-PTRK (7875) or e-mail
To submit your application:
I) E-mail the completed application to ptrack@jndecon.com,
and , ' , ^ '' ,,/'; "./;,.
2) Fax the completed and signed Section E (not Ae entim application^ to, (617) ^^-^w^
If you 'cannot e-mail the application, mail if hard copy of the entire
* "> ' * S jr >* * *
The Performance Track Information Center , , ,
c/o Industrial Economics Incorporated <
2067 Massachusetts Avenue , , ->~!"i
Cambridge, MA 02140 ' ,,.'^S-r-Sl;'';, '~^'-'''",''''?''*'& y'/^'i'
-;?< .. -.. ^ -**&%<,.... .* *"*"* ?* UK"*:". *'*&%>*. %&:
Paperwork Reduction Act Notice
The public reporting and recordkeeping burden for this collection of information is estimated to average
40 hours per response. Burden means the total time, effort, or financial resources expended by persons to
generate, maintain, retain, or disclose or provide information to or for a Federal agency. This includes the
time needed to review instructions; develop, acquire, install, and utilize technology and systems for the
purposes of collecting, validating, and verifying information, processing and maintaining information, and
disclosing and providing information; adjust the existing ways to comply with any previously applicable
instructions and requirements; train personnel to be able to respond to a collection of information; search
data sources; complete and review the collection of information; and transmit or otherwise disclose the
information. An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number.
Send comments on the Agency's need for this information, the accuracy of the provided burden
estimates, and any suggested methods for minimizing respondent burden, including through the use of
automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental
Protection Agency (2822), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB
control number in any correspondence. Do not send the completed form to this address.
Page 14 ApplicationfortheNationalEnvimnmentalPerfomance Track
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United States
Environmental Protection
Agency
Office of Policy Ecomomics
and Innovations (1808)
EPA240-B-01-006
February 2002
For information on how to join the growing number of companies in the forefront of
environmental leadership, visit the National Environmental Performance Track's
Web site at www.epa.gov/performancetrack.
Or contact the Performance Track Information Center at ptrack@indecon.com
or 888-339-PTRK (888-339-7875).
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