Form 6200-02 NPEP Success Story Form

OMB Control No. 2050-0190
Approval Expires: XX/XX/XX

National Partnership for Environmental Priorities (NPEP)
Success Story Outline
The outline provided below offers a framework for making your Success
Story clear and understandable to the many readers that visit the NPEP
website. The outline makes recommendations for approximate length, but
you can make your Success Story as detailed as you wish. If you have a Quality
Assurance/Quality Control Plan for any data you submit, would you please attach it to your
Success Story. Please see the example NPEP Success Story (page 3). If you have any questions, please refer to
epa.gov/minimize/achieve.htm for links to more information.
Section 1: Identifying Information. (As entered on your enrollment form.)
IDENTIFYING INFORMATION
Organization Name:_________________________Facility Name:_____________________________
Address: ________________________________ City/State/Zip: ____________________________
Industrial Sector/NAICS Code: ______________ Parent Company: __________________________
Principal Contact: __________________________Title: ____________________________________
Phone: _________________________________ _Email: ___________________________________
Authorizing Official: _______________________ Title: ____________________________________
RCRA ID Number: ________________________Date: _______________
Enrollment Date:___________________________

Check one of the following options:
____ We have achieved one or more of the goals identified in our enrollment form and would
like to apply for an Achievement Award.
____ We are not applying for an Achievement Award at this time. However, we have
made important progress and would like to submit a Success Story to post on the NPEP
website.
Section 2: Background. (About 100 words.)
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How large is your organization?
How long has your organization been in operation?
What do you produce, and what is the product used for?
How would you describe your customer base?
How do you produce this product?
How much do you produce in a year?
What other environmental partnership programs do you participate in?

Section 3: What NPEP partnership program goal did you set and how did you achieve it? (About 250
words.)
• What chemical(s) did you choose to reduce?
• Why did you pick this chemical(s) to reduce?
• What source reduction, recycling, materials recovery and/or energy recovery goal(s) did you set?
Section 4: What source reduction, recycling, materials recovery, and/or energy recovery alternatives did
you consider? (About 250 words.)
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Source Reduction or Material Management:
o Equipment or technology modifications;
o Reformulation or redesign of products;
o Improvements in inventory control;
o Process or procedure modifications;

EPA Form No. 6200-02 (revised 04/2009)

OMB Conrol No. 2050-0190
Approval Expires: XX/XX/XX

Substitution of less toxic raw materials;
Improvements in maintenance/housekeeping practices;
Other (please describe)
Recycling/Recovery:
o Direct use/reuse in a process to make a product;
o Processing the waste to recover or regenerate a usable product;
o Using/reusing waste as a substitute for a commercial product;
o Other (please describe).
What method did you use to achieve your goal?
What prior successes, if any, helped you achieve this goal?
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Section 5: What hurdles did you face? (About 150 words.)
• Material substitution issues.
• Product quality issues.
• Process change issues.
• Equipment issues.
• Financial issues.
• Customer issues.
• Senior management commitment and support issues.
• Training and/or departmental coordination issues.
• Other (please describe).
Section 6: Results. (About 250 words.)
• Describe and quantify any changes in product content, energy use, and/or environmental releases that
resulted from accomplishing your goal.
• Describe cost savings and/or increases, including changes in capital, production, operations and
maintenance, raw material purchases, waste management, and worker health and safety costs.
• What was the payback period for this project?
• Describe any changes in company policy, management and/or worker involvement, and/or customer
satisfaction that resulted directly or indirectly from this achievement.
Section 7: Lessons Learned. (About 100 words.)
• What lessons learned from this project would you like to share with others?
• What lessons learned extend to other operations or projects in your organization?
Delivery Information
U.S. Mail
Chemical Management Branch, 5306P
1200 Pennsylvania Avenue, NW
Washington, D.C. 20460

Delivery Service
Chemical Management Branch, 5306P
2733 Crystal Drive
Arlington, VA 22202

The public reporting and recordkeeping burden for this collection of information is estimated to average 10 hours per response. Send
comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for
minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division,
U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number
in any correspondence. Do not send the completed form to this address.

EPA Form No. 6200-02 (revised 04/2009)