Best viewed with Internet Explorer 5.0 or higher or Netscape 4.7 or higher. Internet Explorer Netscape Copyright © 2003 Keep Nebraska Beautiful

Program Application The purpose of this form is to help identify any waste or surplus materials from one business, industry, or school that could be utilized by another. Please complete an application for each different material. The more information you provide, the more likely an exchange will occur. Questions? Call Keep Nebraska Beautiful at 1-800-486-4562. (In Lincoln call 486-4562). Name: Company: Address: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip: Telephone: - - Fax: - - E-mail Address: Web Address: http:// Note: Please complete all applicable items. 1) May we release your name/address/phone to interested parties? Yes No 2) Are you SEEKING or GENERATING this material? Seeking Generating 3) Please Specify Material: 4) List Quantity: PER: Day Week Month Quarter Year One Time Only 5) Physical State: (If applicable) Liquid Slurry Solid Semi-SolidSludge Dust Cake Gas Other: 6) Packing: Bulk Drums Dumpsters Gaylords Pallets Bales Other: 7) General Information as Known: (such as chemical composition, type of plastics, main ingredients, cost, pH, toxicity, reactivity, color, particle size, flash point, total solids, purchase date, industrial process that generates this material, contaminants, etc.) 8) Available to Interested Parties: (If applicable) Sample Lab Analysis Independent Analysis 9) Would your company be willing to donate any of the following to schools? (Please check all that apply) Sponges Paper/Cardboard Paints Paper/Cardboard Tubes Clay Wood Scraps Glass Glass/Plastic Containers Dyes Metal Scraps Screen Carpet/Upholstery Scraps Nails Catalogs/Magazines Feathers Plastic/Shredded Plastic Plaster Ink/Press Ink Waxes Sand/Gravel Wire Textiles/Leather/Yarn/String Dried Foods Rubber Scraps 10) Does your company have a newsletter? Yes No Thank you for your interest in the Nebraska Materials Exchange Program. We will keep in contact with you regarding your application, as well as send you our quarterly materials exchange newsletter, The Link.

Materials Exchange PSAs Program Application The Link-Publication City Abbreviations Current Listings