Contra Costa County Green Business Program Enrollment Form
& Application Request

* = Required

Business name: *
Street address: *
City, State Zip Code: *
May we post your business address? Yes No
Website URL (if any):
Contact name: *
E-Mail address: *
Phone number: *
May we post your business phone? Yes No
Type of Business: *
Business Description: *
Describe any green or alternative products you sell:
Are you a home office? Yes No
Does your business have other sites? Yes No
Number of employees: *
Approximate size of business (sq. ft.): *
Is your business Leased Owned
Are you a tenant of a larger building? Yes No
About what year was your building built?
Does your business have a recycling program? Yes No
What size is your garbage container?
How often is it collected?
Does your facility have irrigated landscaping? Yes No
Does your business have any regulatory permits? (e.g. Air Permit, Hazmat, Wastewater, None, etc.)
Do you have a emergency back-up diesel generator on site? Yes No
What hazardous materials do you store onsite (paint, motor oil, pesticides, cleaning products)?
How likely are you to implement changes suggested by? Energy Utilities Not at all Somewhat likely Very likely Water Agencies Not at all Somewhat likely Very likely
How did you hear about this program?
Why do you think you are green?