Retired Engineer Technical Assistance Program (RETAP)

 Pollution Prevention Assessment Request Form

RETAP assessments are always free, confidential, non-regulatory and objective.


Please provide the following information (* required):
 
 

Small Manufacturer Requesting RETAP Assessment 

* Date: 

 
* Business Name:   
Business Website (if available):  
* Total Employees Company-wide:  
   

Facility to be Assessed

Facility Name (if applicable):  
* Street Address:

 

* City:  
* State:  
* Zip Code:  
* Products Manufactured Onsite:  
* Does the company own this facility:   Yes  No
* Will the company sell the
 facility in the next four years?:
  Yes  No
* Total Employees at Facility:   
* Facility Square Footage:   
* Total Operating Hours per Week:  
* Facility Annual Waste Disposal Cost:  $
* Facility Annual Water Cost:  $
* Facility Annual Wastewater Cost:  $
* Facility Annual Energy Cost:  $
   
Needed Pollution Prevention Assistance

 

Discuss the company's goals for reducing waste generation and the use of toxic chemicals, water, and energy:

 
 
Describe the desired assistance in reducing the use of toxic chemicals:
  
 
Describe the desired assistance in reducing hazardous waste generation:
 
 
Describe the desired assistance in reducing liquid industrial by-product generation:
 
 
Describe the desired Source Reduction Planning assistance:
 
 
Describe the desired assistance in reducing non-hazardous solid waste generation:
 
 
Describe the desired assistance in reducing water usage:
 
 
Describe the desired assistance in reducing wastewater generation:
 
 
Describe the desired assistance in reducing energy usage:
 
 
Describe the desired Lean Six Sigma assistance:
 
 
Describe any other desired assistance:
 
 
What is your likely timeframe for developing and completing a pollution prevention or energy conservation project?
 
 
 Contact Person to Confirm and Schedule the RETAP Assessment
* Name (first & last):   
Title:  
* Phone:  
 * Email:  
   
 Individual Submitting Form (if different than above)
Name (first & last):   
Title:  
Phone:  
 Email:  
 

Please let us know how you learned of the RETAP.

 

This form will be forwarded to David Herb, RETAP Manager, to confirm eligibility.
A RETAP Assessment Agreement will be emailed to the Requester if found eligible.  Questions may be directed to
David Herb at herbd@michigan.gov.

 

Michigan Agency for Energy
Michigan Department of Licensing and Regulatory Affairs
517-284-8330