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Mercury Reduction and Recycling for Schools Pledge Program: School Pledge
State Form 51900 (8-04) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT

Send your completed form to IDEM by mailing or faxing it to: School Mercury Contact IDEM - Office of Planning and Assessment 100 North Senate Avenue P.O. Box 6015 Indianapolis, IN 46206-6015 Fax: 317-233-6647 If you have questions or need additional information, please contact IDEM at 800-451-6027 and ask to speak to the School Mercury Contact.

School Pledge
We pledge to continue working with our solid waste management district, IDEM, and/or the Household Hazardous Waste Task Force to keep mercury out of our schools and environment in order to protect the quality of children's health and Indiana's air, land, and water. We understand that mercury performs a useful function in thermometers and other instruments; however, it can also harm the environment. Our school is committed to protecting our students and the environment. Therefore, we, the undersigned Indiana school, have established these goals to minimize the impact of mercury on the environment and encourage our students and their parents to conduct sound environmental practices as well. To achieve these goals, we pledge to participate in the Mercury Awareness Program. As a participant in this program we will: Inventory our buildings for mercury containing items Purchase non mercury-containing substitutes where possible* Implement a phase-out plan for mercury containing devices* Turn in our mercury and mercury containing items for recycling

___________________________________ School Representative ___________________________________ School Name Contact Name ________________________________ School Name Address _________________________________

___________________________________ Solid Waste District Representative __________________________ Date

_____________________________________ ____________________________________________ Fax __________________

Phone ________________

Internet Address ______________________________
*Except fluorescent lamps Send your completed form to IDEM by mailing or faxing it to: School Mercury Contact IDEM - Office of Planning and Assessment 100 North Senate Avenue P.O. Box 6015 Indianapolis, IN 46206-6015 Fax: 317-233-6647