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Apply for an IAC Assessment

Company Information

Company Name *

Company Address *

Specific Plant Name *

City *

State *

Zip Code *

Contact

CEO/Senior Decision Maker Name

CEO/Senior Decision Maker Email

CEO/Senior Decision Maker Phone

Internal Sustainability Contact Name *

Internal Sustainability Contact Email *

Internal Sustainability Contact Phone *

IT Network/Cyber Security Contact Name

IT Network/Cyber Security Contact Email

IT Network/Cyber Security Contact Phone

Process Description

Please briefly describe the process. *

Providing flowcharts/diagrams is highly encouraged

Drop a file here or click to upload Choose File

Maximum file size: 52.22MB

Product & Process Information

NAICS Code *

SIC Code *

Annual Sales *

Number of Employees at Site *

Plant Area *

Principle Product *

Annual Production *

Number/Length of Shifts *

Annual Production Hours

Total Motor Horsepower Capacity

Largest Motor Horsepower

Steam Capacity (LBM/hr)

Max Steam Pressure (PSIG)

Air Compressor Horsepower

Max Compressed Air Pressure (PSIG)

Energy & Environmental Information

What do you estimate as your top five energy-consuming activities or equipment areas?

Electricity & Gas

Electricity Supplier *

Annual Consumption (kWh/year) *

Annual Demand (kW/year) *

Annual Cost ($/year) *

Natural Gas Supplier *

Annual Consumption (therms/year) *

Annual Cost ($/year) *

Other Fuels

Fuel Oil (Gallons/year)

Propane (Gallons/year)

Coal (MMBtu/year)

Other Fuels (if used)

Water

Do you treat process/waste water? *

Yes

No

Annual Water Consumption (Gals/yr) *

Annual Water and Sewer Cost ($) *

Do you use water in your manufacturing process?

Yes

No

Safety Requirements

Steel Toed Shoes: *

Yes

No

Eye Protection: *

Yes

No

Hearing Protection: *

Yes

No

Hard Hat: *

Yes

No

Any respiratory irritants: *

Yes

No

Other Safety Requirements

Waste

Does your process involve the use of specially traced or licensed chemicals or materials?

Yes

No

Does your process create waste requiring costly or mandated disposal methods?

Yes

No

Type of Waste and Annual Disposal Amount & Annual Disposal Cost for Other Liquid Waste (non-hazardous)

Type of Waste and Annual Disposal Amount & Annual Disposal Cost for Other Liquid Waste (hazardous)

Type of Waste and Annual Disposal Amount & Annual Disposal Cost for Solid Waste (non-hazardous)

Type of Waste and Annual Disposal Amount & Annual Disposal Cost for Solid Waste (hazardous)

Gaseous Waste

Additional Notes

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Send Application to

amano@uwm.edu