Hennepin County Environmental Partner Application Form
Organization Name: Click here to enter text.
Address: Click here to enter text.
Website: Click here to enter text.
Primary Point of Contact: Click here to enter text.
Phone: Click here to enter text.
Email: Click here to enter text.
Please check the box next to each decal you are applying for, and fill in the required information below.
☐ We Recycle
1) Who is your recycling hauler? Click here to enter text.
2) Are recycling containers conveniently located next to most garbage bins? If not, why not?
Choose an item.
Click here to enter text.
3) What materials do you collect for recycling? Check all that apply.
☐Paper (office paper, mail, newspaper)
☐Cartons (milk, juice, soup)
☐Plastic cups, food containers
☐Glass bottles and jars
☐Fluorescent light bulbs
☐Batteries
☐Other: Click here to enter text.
☐Boxes (cardboard, paperboard)
☐Plastic bottles and jugs
☐Metal cans and pans
☐Wooden pallets
☐Plastic wrapping and bags
☐Electronics
☐Other: Click here to enter text.
4) Is recycling available to employees? Choose an item.
Is recycling available to customers? Choose an item.
Are recycling bins labeled clearly and properly? Choose an item.
5) Volume of recyclables generated:
Size of recycling dumpsters and/or carts: Click here to enter text.
Number of containers: Click here to enter text.
Frequency of pickup: Click here to enter text. per: Click here to enter text.
6) Cost of current recycling hauling: Click here to enter text. per: Click here to enter text.
Please attach your organization’s last three recycling bills if possible
☐ We Donate Food
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1) Where do you donate edible food? Click here to enter text.
Please provide contact information for each organization you donate to:
Name: Click here to enter text.
Phone: Click here to enter text.
Email: Click here to enter text.
2) Volume of donations:
Size of food donation containers: Click here to enter text.
Number of containers: Click here to enter text.
Frequency of pickup: Click here to enter text. per: Click here to enter text.
☐ We Feed Animals
1) Where do you send your food waste? Click here to enter text.
Please provide contact information for each organization you send food waste to:
Name: Click here to enter text.
Phone: Click here to enter text.
Email: Click here to enter text.
2) Is food waste collection available to employees? Choose an item.
Is food waste collection available to customers? Choose an item.
Are collection bins labeled clearly and properly? Choose an item.
3) Volume of donations:
Size of food waste dumpsters and/or carts: Click here to enter text.
Number of containers: Click here to enter text.
Frequency of pickup: Click here to enter text. per: Click here to enter text.
☐ We Compost
1) Who is your organic waste hauler? Click here to enter text.
2) What materials do you collect? Check all that apply.
☐Food Scraps
☐Non-recyclable paper (napkins, paper cups, etc.)
☐ Compostable foodware
3) Is organics collection available to employees? Choose an item.
Is organics collection available to customers? Choose an item.
Are collection bins labeled clearly and properly? Choose an item.
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4) What brand of compostable plastic bags do you use? What’s your source for purchasing these
bags? Click here to enter text.
5) Do you use compostable foodware? What items? What’s your source for purchasing these
items? Click here to enter text.
6) Volume of organic waste for compost:
Size of organics for composting dumpsters and/or carts: Click here to enter text.
Number of containers: Click here to enter text. Per: Click here to enter text.
Frequency of pickup: Click here to enter text. Per: Click here to enter text.
7) Cost of current compostable material hauling: Click here to enter text. Per: Click here to enter
text.
Please attach your last three organics bills if possible and not composting on site
Additional sustainability efforts
Please enter any waste reduction, energy efficiency, green purchasing or other sustainability activities
your organization engages in.
Click here to enter text.
Click here to enter text.
Does the organization include solid waste management in its training of new employees?
☐ Yes ☐ No
Statement of Certification
I certify that this document and all attachments were prepared under my direction or supervision in
accordance with a system to assure that qualified personnel properly gather and evaluate the
information submitted, and that the statements and information in the document are true, accurate and
complete.
I further certify that to the best of my knowledge, the facility is in compliance with all applicable
environmental regulations as set forth by Federal, State and local agencies, and understand that any
non-compliance or change in current practices may result in the revocation of the Hennepin County
Environmental Partner award.
Signature ___________________________________________
Name (Please print if handwritten) ___________________________________________
Date ___________________________________________
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Upon receiving your application a specialist from Environmental Services will reach out to you within
5-10 business days to schedule a 30 minute site visit to verify your application.
For office use only:
Decals Distributed/Recognition Awarded
☐ We Recycle
☐ We Feed People
☐ We Feed Animals
☐ We Compost
☐ Would like electronic copy of decal image
☐Table tents
☐Organization would like to be included in online directory/story map
☐ Photograph business for story map
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