Activity ID (please refer to OPPTA letter):

1. How did you hear about OPPTA Services?
   
   IDEM Web Site Inspection/Enforcement referral Called main IDEM phone number and was transferred to CTAP Other IDEM office referral Indiana Department of Commerce Trade Journal Chamber of Commerce Local Economic Development Office Self Audit/Environmental Management System Consultant Written Materials Other
   
   If other, please describe:
   
   
2. How long has your business been operating?
   
   Less than 1 Year 1-5 Years More than 5 Years
   
   
3. How many employees do you have at your facility
   
   1-10 11-25 26-50 51-100 More than 100
   
   
4. What areas did you need assistance with? Please check all that apply. 
   
   Pollution Prevention
   Recycling
   Recognition/Awards or OPPTA programs
   Air
   Water
   Waste
   Clean Up/Contamination
   Spill Rule
   Industry-specific (drycleaner, vehicle maintenance shop, etc..)
   
   
   
   Other
   
   
   
   
5. What type of assistance were you provided?
   
   Phone Assistance
   On-site Visit
   Workshop
   Other
   
   
6. Please rate the services you received from OPPTA on a scale from 1 to 5 for each of the following areas:
   (5-Excellent, 4-Very good, 3-Good, 2-Satisfactory, 1-Unsatisfactory)
   
   5 - Excellent 4 - Very Good 3 - Good 2 - Satisfactory 1 - Unsatisfactory Staff knowledge
   5 - Excellent 4 - Very Good 3 - Good 2 - Satisfactory 1 - Unsatisfactory Relevance of the recommendations to your facility
   5 - Excellent 4 - Very Good 3 - Good 2 - Satisfactory 1 - Unsatisfactory Timeliness of follow-ups, meetings, and returned calls
   5 - Excellent 4 - Very Good 3 - Good 2 - Satisfactory 1 - Unsatisfactory Usefulness of recommendations, reports, and materials
   

COMPLIANCE ASSISTANCE: (if P2 please skip to #9)

7. For which environmental media was compliance assistance provided? Check all that apply.
   
   Air
   Hazardous Waste
   Wastewater
   Stormwater
   Underground Storage Tanks
   Polychlorinated Biphenyls (PCB's)
   Monitoring
   Permitting (air, water or land)
   General
   OSHA
   Drinking Water
   Solid Waste
   Spill
   Toxic Release Inventory
   Recordkeeping Requirements
   
   
8. What environmental or economic impact did you receive as a result of working with CTAP?
   
   Reduced risk of enforcement
   Use of Self-Disclosure Policy and reduced penalties
   Improved worker safety/health Improvement to operational efficiency
   Other (please explain):
   
   
   

   (Skip to #11)

POLLUTION PREVENTION (P2):

9. What Pollution Prevention activities or operational changes, if any, were implemented at the facility based on suggestions from OPPTA?
   
   Employee Training
   Spill/leak Prevention
   Waste Segregation
   Inventory and Materials Handling
   Closed-loop Recycling
   Energy Efficiency
   Map Processes
   Modify Equipment
   Improve Equipment Efficiency
   Substitute Hazardous Materials with Less Hazardous Materials
   Direct Reuse
   Water Conservation
   Develop a P2 Team
   Develop an EMS (ie. ISO 14001)
   Modify Process
   
   
10. For those projects implemented, please indicate the results by completing the following section.
    
    If you would like assistance from OPPTA in completing this section, please check here:
    
     

    lbs/yr Reduction in Toxic/Hazardous Materials Used	Initial Cost (non capital) (capital) Savings (one time) (annually)
    lbs/yr Reduction in Raw Materials Used	Initial Cost (non capital) (capital) Savings (one time) (annually)
    gal/yr Reduction in Water Used	Initial Cost (non capital) (capital) Savings (one time) (annually)
    Reduction in Energy/Fuel kWh/yr Electricity therms/yr Natural Gas tons/yr Coal gal/yr Diesel Fuel miles/yr Vehicle Miles gal/yr Water Usage Other	Initial Cost (non capital) (capital) Savings (one time) (annually)
    Waste Reduced lbs/yr Hazardous Waste lbs/yr Hazardous Waste Diverted to Recycling/Reuse	Initial Cost (non capital) (capital) Savings (one time) (annually)
    Did you lower your status to an SQG?
    lbs/yr Solid Waste lbs/yr Solid Waste Diverted to Recycling/Reuse	Initial Cost (non capital) (capital) Savings (one time) (annually)
    Air Releases Reduced tons/yr CO2 Reduced tons/yr NOx Reduced tons/yr SOx Reduced tons/yr PM Reduced tons/yr VOCs Reduced (Non-HAP) tons/yr HAP Reduced tons/yr Other	Initial Cost (non capital) (capital) Savings (one time) (annually)
    Wastewater Reduced gal/yr Industrial Wastewater Discharge Avoided	Initial Cost (non capital) (capital) Savings (one time) (annually)

    
    
11. What is your primary job responsibility?
    
    Owner/Operator Safety and/or Environmental Compliance Human Resources Engineering Plant Management Other
    
    If Other, please describe:
    
    
    
12. Would you like to receive IDEM-OPPTA updates and regulatory information via e-mail?
    
    Yes (e-mail address)
    No
    
    
13. Would you use OPPTA again?
    

    Yes
    No
    

14. Please give any suggestions that could improve OPPTA services.
    
    
    Your Name:  (Optional)
    
    Your Phone Number:  (Optional)
    
    THANK YOU FOR TAKING THE TIME TO FILL OUT OUR SURVEY.