Public Water Infrastructure Initial Contact Form

Public Water Infrastructure Energy Efficiency Assessment Initial Contact Form

Energy efficiency assessments are being conducted at no cost for publicly owned water and wastewater treatment works. If your facility is publicly owned, you may qualify for this service. All information on the form is required. Once the form is submitted, you will be contacted by email with instructions to submit more detailed information.

Funding for this program is provided in whole or in part by the Illinois EPA Office of Energy.

1. Primary Contact Name:

2. Title:

3. Phone: answer must be phone number with area code like 217-333-1000

4. E-Mail: answer must be an email address

5. Organization / Company Name:

6. Street Address:

7. Street Address 2:

8. City:

9. State:

10. ZIP Code: answer must be a zipcode like 61864 or 61864-8180

Please list an additional contact for this assessment. It could be the plant operator, public works director, city manager, etc.

11. Secondary Contact Name:

Please list an additional contact for this assessment. It could be the plant operator, public works director, city manager, etc.

12. Secondary Contact Title:

13. Secondary Contact Email:

14. Secondary Contact Phone Number:

15. Are you seeking an assessment for:

15. Are you seeking an assessment for:

Wastewater Treatment Plant

Water Treatment Plant

Both Water and Wastewater Treatment Plants

16. Is the PWI facility located in Illinois AND owned by the State of Illinois or an Illinois unit of local government?

Yes

No

17. Are you willing to allow ISTC/SEDAC engineers access to the facility and access the most recent utility data for electricity and natural gas?

Yes

No

18. Are you willing to provide information to ISTC and/or SEDAC upon request?

Yes

No

19. Are you willing to acknowledge IEPA ownership of the assessment report?

Yes

No

20. Have you worked with ISTC or SEDAC before?

Yes

No

21. Spam prevention - Please enter the sum of 1 plus 2: answer must be numeric

limited to 1 characters.

Illinois Sustainable Technology Center

Public Water Infrastructure Initial Contact Form

Public Water Infrastructure Energy Efficiency Assessment Initial Contact Form

1. Primary Contact Name:

2. Title:

3. Phone: answer must be phone number with area code like 217-333-1000

4. E-Mail: answer must be an email address

5. Organization / Company Name:

6. Street Address:

7. Street Address 2:

8. City:

9. State:

10. ZIP Code: answer must be a zipcode like 61864 or 61864-8180

11. Secondary Contact Name:

12. Secondary Contact Title:

13. Secondary Contact Email:

14. Secondary Contact Phone Number:

15. Are you seeking an assessment for:

16. Is the PWI facility located in Illinois AND owned by the State of Illinois or an Illinois unit of local government?

17. Are you willing to allow ISTC/SEDAC engineers access to the facility and access the most recent utility data for electricity and natural gas?

18. Are you willing to provide information to ISTC and/or SEDAC upon request?

19. Are you willing to acknowledge IEPA ownership of the assessment report?

20. Have you worked with ISTC or SEDAC before?

21. Spam prevention - Please enter the sum of 1 plus 2: answer must be numeric