Application Form for the Sixteenth
Annual New Hampshire Governor’s
Award for Pollution Prevention
Business or Organization: ________________________________________________________
Contact Name & Title: ___________________________________________________________ Street Address: _________________________________________________________________ City: _________________________________________________ Zip: ___________________ Telephone: _____________________ Fax: _______________ Email: _____________________ Website: ____________________________Number of Employees at this address:___________
; Completed projects with measurable data that adhere to the definition of pollution prevention as it is
used in RSA 21-O: 17 are eligible. "Pollution prevention'' means the use of materials, processes, or
practices that reduce or eliminate the creation of pollutants or wastes at the source, or minimize their
release into the environment prior to recycling, treatment, or disposal.
; The P2 Governor’s Award is for projects that show pollution prevention within the process, not solely
in a product. A company with a “green” product is welcome to apply as long as one of their customers
is a co-applicant and can show how their product has led to measurable pollution reductions in the
; The judges will be looking for a well established pollution prevention project that goes above and
beyond; for example, a recycling program for employees. A recycling project can be partnered with a
; Applicants must be in good standing with state and federal environmental laws. ; Award recipients must agree to allow a summary of their accomplishments to be published by the
; Projects must be performed in NH plants. For product applications, the product must be manufactured
Applications are due by April 1, 2010.
It is important to completely answer all sections that apply to your project. A comparison will be made of all applications received, based upon the information submitted. Should we require any further information, NHPPP will contact you. Please type or print neatly.
The preferred method of application submittal is via e-mail. Please send application and attachments
to email@example.com. The application and attachments should not be any larger than 20MB.
For frequently asked questions, application examples, how winners are selected and other relevant information, please view the N.H. Governor’s Award web page at
http://des.nh.gov/organization/commissioner/p2au/pps/ppgap/index.htm. The winners of the Sixteenth
Annual Governor’s Award for Pollution Prevention will be notified by Summer 2010.
Sections 1 through III: Please describe each project using each section’s questions to guide you.
Although you may provide supplemental information, remember that this is the information the judges will use to compare your application to others.
Section I. Business & Projects Descriptions
Description of Business or Organization and your products:
Brief Project descriptions:
Why were the projects undertaken?
Project contact (if different from contact name given on page 1):
*“Project” can mean a specific project, a facility-wide program, or a major outreach/education activity.
Section II. Adherence to Pollution Prevention Hierarchy
Pollution Prevention encompasses a wide variety of activities. Some activities are more “environmentally
preferable” than others and are therefore given an order of preference. This order, referred to as the Pollution Prevention Hierarchy, is:
1. Elimination or reduction of a hazardous or non-hazardous raw material
2. Reduction or elimination of the toxicity or volume of a hazardous or non-hazardous waste
3. Direct reuse of a waste
4. Indirect reuse of a waste through on-site recycling
Describe how each project fits within the P2 hierarchy using the questions as outlined in Section III.
Section III. Project Description and Measurement
Provide information and results describing and detailing the implementation and success of each project as it relates to the measurement categories. Some projects will have measurable results in several categories. For example, the elimination of a solvent degreasing agent by replacing it with an aqueous degreaser will result in the elimination of a hazardous raw material; it will result in a reduction of hazardous wastes generated; and it might result in a reduction in air emissions. Consider the measurement categories and project questions as a guide to help you describe each project and its results. Measurement Categories:
; Reduction or elimination of raw materials
; Reduction or elimination of hazardous materials and or wastes
; Reduction in the toxicity of hazardous wastes
; Reduction in air emissions
; Reduction in water consumption
; Reduction in wastewater discharges
; Reduction or elimination of solid wastes
; Describe the project in detail, making sure it is a pollution prevention strategy (substitution for a
hazardous material, new equipment to reduce waste, manufacturing process changes, reuse of a
; How was the project implemented? What problems were overcome?
; What raw materials and/or wastes (hazardous or non-hazardous) were affected?
o Quantity of raw materials used, or wastes generated, prior to the project (lbs, gal, etc.)?
o Quantity of raw materials or wastes reduced or eliminated (lbs, gal, etc.)?
; Provide energy savings from each individual project in kWh.
. ; Calculate the emissions reductions for greenhouse gases, such as CO2
; What are the water savings from each individual project in gallons?
; What is the payback period (real or estimated)? What are the estimated cost savings per year? Additional Hidden Savings
Please describe any other reduction measures that were realized as a result of the project (that are not already in the ROI calculation above)
Reduced/Saved Time __Yes __No
Labor Savings __Yes __No
Administrative Costs __Yes __No
Risk __Yes __No
Increased Training __Yes __No
If yes to any of these areas, please provide actual savings.
Did these measures result in cost savings? __Yes __No
For “Product” applications
If you are applying for an award for an environmentally beneficial product you created or produce, there are three areas of information that must be provided for your application to be considered:
; A full description of the product manufacturing process to be sure that the process you use to
make your product is environmentally acceptable;
; A statement from one or more of your clients describing how they use your product as a
pollution prevention technique in their company; and
; Sections IV and V must be complete.
Section IV. Commitment and Leadership in Pollution Prevention
All applicants and co-applicants need to fill out this section with regard to their own business operations. Explain your management commitment of pollution prevention and overall environmental excellence. Examples include: employee training, incentive programs, awards, planning meetings, a pollution prevention policy, an environmental purchasing policy, or supply chain collaboration. If available, please attach a copy of your mission statement, policy or vision on pollution prevention. Answering “no” to any
of these questions does not disqualify a candidate from receiving an award.
Does the facility have an environmental management system? __Yes __No
Is your facility ISO 14001 certified? __Yes __No
If yes to either of these questions, please explain your reasons for implementation. Do you have a program to actively seek non-toxic packaging above and beyond the minimum legal requirements? __Yes __No __Don’t Know
Has your facility implemented a lighting retrofit? __Yes __No __Don’t Know
Has education and outreach training on the company’s P2 efforts been included in employee trainings?
Has your facility improved supply chain sustainability? __Yes __No
If yes, explain what has been done.
Section V. Benefits to Employees & Community Describe any benefits of this project or program to the community. Have community relations improved as a result of this project? ___Yes ___No If yes, please describe.
Have benefits to employees resulted from this project?
Improved Worker Safety __Yes __No
Increased production __Yes __No
Increased morale __Yes __No
If yes, please describe.
Section VI. Additional Information
Please provide, if necessary, any additional information not addressed in this application. You may also
attach to this application any documents (e.g., brochures, press releases or web addresses) that you believe
would be helpful to your application.