Strategic Goals Program Worksheet

Use this form to submit your SGP worksheet data for 2007 or prior years. It can also be used to add or change data that you previously submitted. When used for this purpose, only enter the new data.

Note: For companies that previously submitted SGP worksheet data, you can review your historical submissions here. You will need to know your company's four-digit database number DBN.

Part 1. Contact and Company Information
* Your Name:
* Company Name:
* Company Address:
* City:
* State:
* Zip:
* E-mail:
* Phone:
* Fax:
Type of Facility
DBN (if you know it):

Part 2. Accounting for Changes in Production
Enter the year for which this data applies: (yyyy)
NOTE: All subsequent entries on this form
apply only to the year entered above.
Annual sales: $
Annual production labor hours: (hrs)

Part 3. Water and Wastewater.
Does your facility discharge metal finishing wastewate?
Volume of metal finishing water discharged: (gals)

Enter the concentration of metals in your wastewater discharged:
Cadmium: (mg/L)Chromium: (mg/L)
Copper: (mg/L)Cyanide: (mg/L)
Lead: (mg/L)Nickel: (mg/L)
Silver: (mg/L)Zinc: (mg/L)

Part 4. Wastewater Treatment Sludge
Total amount of wastewater treatment sludge generated: (lbs)
Total amount of hazardous wastewater treatment
sludge shipped offsite for land disposal:		 (lbs)
Total amount of wastewater treatment sludge
shipped offsite for land recycle/recovery:		 (lbs)
Average water content of sludge: (%)

Part 5. Organic Emissions to Air and Water
Total amount of organic emissions to air and water: (lbs)

Part 6. Energy Use in Metal Finishing Operations
Electricity: (kWHrs)
Natural Gas: (therms)
Fuel oil or propane: (gals)

Part 7. Reduction in Human Exposure to Toxic Materials.
During the year to which this data applies, a written program was in place to train workers on workplace exposures and hazards.
During the year to which this data applies, contingency/emergency response plans were reviewed, updated and communicated to the Local Emergency Planning Committee (LEPC).
During the year to which this data applies, a system was established or in place where all employees can generate, propose, and implement pollution prevention ideas.
During the year to which this data applies, opportunities to substitute hazardous chemicals with non-hazardous or less hazardous chemicals were investigated.

Part 8. Resource Utilization and Compliance-Related Unit Costs
Cost for 1000 gallons of water: $ (/1000 gal)
One unit of electricity: $ (/kWHr)
One unit of natural gas: $ (/therm)
One lb. of sludge sent to landfill for recycle
(include transportation, disposal/recycle): $		 (/gal)

Part 9. Benchmarking.
Enter the percentage of your metal finishing production that was derived from each process:
Zinc Rack: (%)Zinc Barrel: (%)
Decorative Chrome Plating: (%)Nickel Electroplating: (%)
Electroless Nickel Plating: (%)Anodizing (non-Cr): (%)
Hard Chrome Plating: (%)Silver Plating: (%)
Other Precious Metals Plating: (%)Chromating: (%)
Other Coversion Coating
(like phosphating):		 (%)Other Aqueous Finishing
(like passivation):		 (%)
Paint or Powder Coat: (%)Other Plating: (%)

Part 10. Additional Comments or Explanations.

Questions or comments? Contact George Cushnie.