------------------------- ------------------------------- -------------- ------------------------ ---------------- ------------ -------------------------- ----------- -------------------------
  **[Date:]{.underline}**   **[Contractor:]{.underline}**                  **[Contact                                             **[Phone:]{.underline}**               **[Email
                                                                           Person:]{.underline}**                                                                        Address:]{.underline}**

  **     **                 **     **                                      **     **                                              **     **                              **     **

                                                                                                                                                                         

  **Project Description:                                                                                             **Purchase                                          
       **                                                                                                            Order No.:                                          
                                                                                                                          **                                             

  **Reporting Period:**                                     **Monthly**                             **Quarterly**                                            **End of    
                                                                                                                                                             project**   

  **Did not purchase any                                                                                                                                                 
  *recycled* or *biobased*                                                                                                                                               
  materials for this                                                                                                                                                     
  project this reporting                                                                                                                                                 
  period.**                                                                                                                                                              
  ------------------------- ------------------------------- -------------- ------------------------ ---------------- ------------ -------------------------- ----------- -------------------------

+----------------------------+-------------------+-------------+------+
| Definitions and            |                   |             |      |
| information for products   |                   |             |      |
| and their qualifying       |                   |             |      |
| biobased content are       |                   |             |      |
| listed at**:               |                   |             |      |
| <                          |                   |             |      |
| http://www.biobased.oce.us |                   |             |      |
| da.gov/public/index.cfm>** |                   |             |      |
+----------------------------+-------------------+-------------+------+
| **Biobased Materials**     | **Total**         | **Purchase  | **   |
|                            |                   | Amount (\$) | Cumu |
|                            | **Amount Meets    | this        | lati |
|                            | Minimum**         | period**    | ve** |
|                            |                   |             |      |
|                            | ***Biobased*      | **(Cost to  | **t  |
|                            | Content           | Sandia)**   | otal |
|                            | Requirements**    |             | to   |
|                            |                   |             | da   |
|                            |                   |             | te** |
+----------------------------+-------------------+-------------+------+
| Hydraulic Fluid -- Mobile  | Yes No            | **     **   | *    |
| Equipment -- 24%           |                   |             | *    |
|                            | Yes No            | **     **   |   ** |
| Penetrating Lubricants --  |                   |             |      |
| 71%                        | Yes No            | **     **   | *    |
|                            |                   |             | *    |
| Urethane Roof Coatings --  | Yes No            | **     **   |   ** |
| 62%                        |                   |             |      |
|                            |                   |             | *    |
| Water Tank Coatings -- 62% |                   |             | *    |
|                            |                   |             |   ** |
|                            |                   |             |      |
|                            |                   |             | *    |
|                            |                   |             | *    |
|                            |                   |             |   ** |
+----------------------------+-------------------+-------------+------+
| Definitions and            |                   |             |      |
| information for products   |                   |             |      |
| and their qualifying       |                   |             |      |
| recycled content are       |                   |             |      |
| listed at**:               |                   |             |      |
| <http://www.e              |                   |             |      |
| pa.gov/cpg/products.htm>** |                   |             |      |
+----------------------------+-------------------+-------------+------+

+----------------------------+-------------------+-------------+------+
| **Recycled Materials**     | **Total**         | **Purchase  | **   |
|                            |                   | Amount (\$) | Cumu |
|                            | **Amount Meets    | this        | lati |
|                            | Minimum**         | period**    | ve** |
|                            |                   |             |      |
|                            | ***Recycled*      | **(Cost to  | **t  |
|                            | Content           | Sandia)**   | otal |
|                            | Requirements**    |             | to   |
|                            |                   |             | da   |
|                            |                   |             | te** |
+----------------------------+-------------------+-------------+------+
| [^1]Concrete and Cement -- | Yes No            |             |      |
| must contain fly ash       |                   |             |      |
+----------------------------+-------------------+-------------+------+
| [^2]Flowable Fill -- must  | Yes No            |             |      |
| contain fly ash            |                   |             |      |
+----------------------------+-------------------+-------------+------+
| [^3]Building Insulation    | Yes No            |             |      |
|                            |                   |             |      |
| Fiberglass -- Glass Cullet | Yes No            |             |      |
| -- 20%                     |                   |             |      |
|                            | Yes No            |             |      |
| Rock Wool -- Slag -- 75%   |                   |             |      |
|                            | Yes No            |             |      |
| Cellulose (loose fill or   |                   |             |      |
| spray-on) -- Paper 75%     | Yes No            |             |      |
|                            |                   |             |      |
| Perlite Composite -- Paper | Yes No            |             |      |
| -- 23%                     |                   |             |      |
|                            | Yes No            |             |      |
| Foam in Place-Plastic      |                   |             |      |
| Resin -- 5%                | Yes No            |             |      |
|                            |                   |             |      |
| Glass Fiber Reinforced     | Yes No            |             |      |
| Foam -- Plastic Resin --   |                   |             |      |
| 6%                         |                   |             |      |
|                            |                   |             |      |
| Phenolic Rigid Foam --     |                   |             |      |
| Plastic Resin -- 5%        |                   |             |      |
|                            |                   |             |      |
| Rigid Foam -- Plastic      |                   |             |      |
| Resin- 9%                  |                   |             |      |
|                            |                   |             |      |
| Plastic, non-woven bat --  |                   |             |      |
| Plastic -- 100%            |                   |             |      |
+----------------------------+-------------------+-------------+------+
| [^4]Latex Paint -- (list   | Not Yet           |             |      |
| all latex paint purchases) | Applicable --     |             |      |
|                            | List Total \$\$   |             |      |
|                            | -\>               |             |      |
+----------------------------+-------------------+-------------+------+
| [^5]Non-Pressure Pipe      | Yes No            |             |      |
|                            |                   |             |      |
| Steel -- 25 to 100%        | Yes No            |             |      |
|                            |                   |             |      |
| HDPE -- Plastic -- 100%    | Yes No            |             |      |
|                            |                   |             |      |
| PVC -- Plastic -- 25%      | Yes No            |             |      |
|                            |                   |             |      |
| Concrete -- Must contain   |                   |             |      |
| fly ash                    |                   |             |      |
|                            |                   |             |      |
+----------------------------+-------------------+-------------+------+
| [^6]Floor Tiles -- Plastic | Yes No            |             |      |
| or Rubber -- 90%           |                   |             |      |
|                            | Yes No            |             |      |
| Patio Blocks -- Plastic or |                   |             |      |
| Rubber -- 90%              |                   |             |      |
+----------------------------+-------------------+-------------+------+
| [^7]Shower and Restroom    | Yes No            |             |      |
| Dividers                   |                   |             |      |
|                            | Yes No            |             |      |
| Plastic -- 20%             |                   |             |      |
|                            |                   |             |      |
| Steel -- 25 to 100%        |                   |             |      |
+----------------------------+-------------------+-------------+------+
| [^8]Mats/Walkway Pads      | Yes No            |             |      |
|                            |                   |             |      |
| Rubber -- 85%              | Yes No            |             |      |
|                            |                   |             |      |
| Plastic -- 100%            | Yes No            |             |      |
|                            |                   |             |      |
| Rubber/Plastic -- 100%     |                   |             |      |
|                            |                   |             |      |
+----------------------------+-------------------+-------------+------+
| Carpet Cushion/Backing --  | Yes No            |             |      |
| Synthetic Materials --     |                   |             |      |
| 100%                       |                   |             |      |
+----------------------------+-------------------+-------------+------+
| [^9]Roofing Materials      | Yes No            |             |      |
|                            |                   |             |      |
| Steel -- 25 to 100%        | Yes No            |             |      |
|                            |                   |             |      |
| Aluminum -- 20%            | Yes No            |             |      |
|                            |                   |             |      |
| Felt or Fiber Composite -- | Yes No            |             |      |
| Felt or Fiber -- 50%       |                   |             |      |
|                            | Yes No            |             |      |
| Rubber -- 100%             |                   |             |      |
|                            | Yes No            |             |      |
| Plastic or Rubber          |                   |             |      |
| Composite -- 100%          | Yes No            |             |      |
|                            |                   |             |      |
| Wood/Plastic Composite --  |                   |             |      |
| 100%                       |                   |             |      |
|                            |                   |             |      |
| Cement -- Must contain fly |                   |             |      |
| ash                        |                   |             |      |
|                            |                   |             |      |
+----------------------------+-------------------+-------------+------+
| [^10]Pallets               | Yes No            |             |      |
|                            |                   |             |      |
| Wood -- 95%                | Yes No            |             |      |
|                            |                   |             |      |
| Plastic Thermoformed --    | Yes No            |             |      |
| Plastic -- 25%             |                   |             |      |
|                            | Yes No            |             |      |
| Plastic Lumber -- Plastic  |                   |             |      |
| -- 100%                    |                   |             |      |
|                            |                   |             |      |
| Paperboard -- Paper -- 50% |                   |             |      |
+----------------------------+-------------------+-------------+------+
| [^11]Blasting Grit         | Yes No            |             |      |
|                            |                   |             |      |
| Steel -- 25 to 100%        | Yes No            |             |      |
|                            |                   |             |      |
| Coal Slag -- 100%          | Yes No            |             |      |
|                            |                   |             |      |
| Copper and Nickel Slag --  | Yes No            |             |      |
| 100%                       |                   |             |      |
|                            | Yes No            |             |      |
| Bottom Ash -- 100%         |                   |             |      |
|                            | Yes No            |             |      |
| Glass -- 100%              |                   |             |      |
|                            | Yes No            |             |      |
| Glass/Plastic -- 100%      |                   |             |      |
|                            | Yes No            |             |      |
| Fused Alumina Oxide --     |                   |             |      |
| 100%                       |                   |             |      |
|                            |                   |             |      |
| Walnut Shells -- 100%      |                   |             |      |
|                            |                   |             |      |
|                            |                   |             |      |
|                            |                   |             |      |
|                            |                   |             |      |
+----------------------------+-------------------+-------------+------+
| [^12]Industrial Drums      | Yes No            |             |      |
|                            |                   |             |      |
| Steel -- 25 to 100%        | Yes No            |             |      |
|                            |                   |             |      |
| Plastic -- 30%             | Yes No            |             |      |
|                            |                   |             |      |
| Fiber -- Paper -- 100%     |                   |             |      |
|                            |                   |             |      |
+----------------------------+-------------------+-------------+------+
| [^13]Mulch                 | Yes No            |             |      |
|                            |                   |             |      |
| Paper-based -- Paper --    | Yes No            |             |      |
| 100%                       |                   |             |      |
|                            | Yes No            |             |      |
| Wood -- Wood/Paper -- 100% |                   |             |      |
|                            |                   |             |      |
| [^14]Compost, Yard         |                   |             |      |
| Trimmings and Food Waste   |                   |             |      |
| -- any %                   |                   |             |      |
+----------------------------+-------------------+-------------+------+
| [^15]Modular Threshold     | Yes No            |             |      |
| Ramps                      |                   |             |      |
|                            | Yes No            |             |      |
| Steel -- 25 to 100%        |                   |             |      |
|                            | Yes No            |             |      |
| Aluminum -- 10%            |                   |             |      |
|                            |                   |             |      |
| Rubber -- 100%             |                   |             |      |
+----------------------------+-------------------+-------------+------+
| [^16]Bike Racks            | Yes No            |             |      |
|                            |                   |             |      |
| Steel -- 25 to 100%        | Yes No            |             |      |
|                            |                   |             |      |
| HDPE -- Plastic -- 100%    |                   |             |      |
+----------------------------+-------------------+-------------+------+
| [^17]Signage               | Yes No            |             |      |
|                            |                   |             |      |
| Plastic -- 80%             | Yes No            |             |      |
|                            |                   |             |      |
| Aluminum -- 25%            | Yes No            |             |      |
|                            |                   |             |      |
| Plastic Sign Posts --      | Yes No            |             |      |
| Plastic -- 80%             |                   |             |      |
|                            |                   |             |      |
| Steel Sign Posts -- Steel  |                   |             |      |
| -- 25 to 100%              |                   |             |      |
+----------------------------+-------------------+-------------+------+

+----------------------------+-------------------+------------+------+
| [^18]Strapping             | Yes No            |            |      |
|                            |                   |            |      |
| Polyester -- Plastic --    | Yes No            |            |      |
| 50%                        |                   |            |      |
|                            | Yes No            |            |      |
| Polypropylene -- Plastic   |                   |            |      |
| -- 10%                     |                   |            |      |
|                            |                   |            |      |
| Steel -- 25 to 100%        |                   |            |      |
+----------------------------+-------------------+------------+------+
| [^19]Office Furniture      | Yes No            |            |      |
| *(Call contact number      |                   |            |      |
| below first)*              | Yes No            |            |      |
|                            |                   |            |      |
| Steel Structure -- 25%     | Yes No            |            |      |
|                            |                   |            |      |
| Aluminum Structure -- 75%  | Yes No            |            |      |
|                            |                   |            |      |
| Particleboard/Fiberboard   | Yes No            |            |      |
| -- Wood -- 80%             |                   |            |      |
|                            | Yes No            |            |      |
| Particleboard/Fiberboard   |                   |            |      |
| -- Agricultural Fiber --   |                   |            |      |
| 100%                       |                   |            |      |
|                            |                   |            |      |
| Fabric -- PET -- 100%      |                   |            |      |
|                            |                   |            |      |
| Plastic Component -- HDPE  |                   |            |      |
| -- 95%                     |                   |            |      |
+----------------------------+-------------------+------------+------+
| [^20]Park Benches or       | Yes No            |            |      |
| Picnic Tables              |                   |            |      |
|                            | Yes No            |            |      |
| Plastic -- 100%            |                   |            |      |
|                            | Yes No            |            |      |
| Plastic Composite --       |                   |            |      |
| Plastic -- 100%            | Yes No            |            |      |
|                            |                   |            |      |
| Aluminum -- 25%            | Yes No            |            |      |
|                            |                   |            |      |
| Steel -- 25 to 100% see    |                   |            |      |
| website                    |                   |            |      |
|                            |                   |            |      |
| Concrete -- Must contain   |                   |            |      |
| fly ash                    |                   |            |      |
+----------------------------+-------------------+------------+------+
| [^21]Hose                  | Yes No            |            |      |
|                            |                   |            |      |
| Garden -- Rubber or        | Yes No            |            |      |
| Plastic -- 60%             |                   |            |      |
|                            |                   |            |      |
| Soaker -- Rubber or        |                   |            |      |
| Plastic -- 60%             |                   |            |      |
+----------------------------+-------------------+------------+------+
| [^22]Plastic Fencing --    | Yes No            |            |      |
| Plastic -- 90%             |                   |            |      |
+----------------------------+-------------------+------------+------+
| [^23]Structural Fiberboard | Yes No            |            |      |
| -- Paper -- 80%            |                   |            |      |
|                            | Yes No            |            |      |
| Laminated Paperboard --    |                   |            |      |
| Paper -- 100%              |                   |            |      |
+----------------------------+-------------------+------------+------+
| [^24]Traffic Control       | Yes No            |            |      |
| Devices                    |                   |            |      |
|                            | Yes No            |            |      |
| Plastic Channelizers --    |                   |            |      |
| Plastic -- 25%             | Yes No            |            |      |
|                            |                   |            |      |
| Rubber Channelizers (Base  | Yes No            |            |      |
| Only) -- Rubber -- 100%    |                   |            |      |
|                            | Yes No            |            |      |
| Plastic and Flexible       |                   |            |      |
| Delineators -- Plastic --  | Yes No            |            |      |
| 25%                        |                   |            |      |
|                            | Yes No            |            |      |
| Rubber Delineators (Base   |                   |            |      |
| Only) -- Rubber -- 100%    | Yes No            |            |      |
|                            |                   |            |      |
| Steel Delineators (Base    | Yes No            |            |      |
| Only) -- Steel -- 25 to    |                   |            |      |
| 100%                       | Yes No            |            |      |
|                            |                   |            |      |
| Plastic Traffic Cones --   | Yes No            |            |      |
| Plastic -- 50%             |                   |            |      |
|                            | Yes No            |            |      |
| Crumb Rubber Traffic Cones |                   |            |      |
| -- Rubber- 50%             |                   |            |      |
|                            |                   |            |      |
| Steel Traffic Barricades   |                   |            |      |
| -- Steel -- 25 to 100%     |                   |            |      |
|                            |                   |            |      |
| Fiberglass Traffic         |                   |            |      |
| Barricades - Plastic or    |                   |            |      |
| Rubber -100%               |                   |            |      |
|                            |                   |            |      |
| Plastic Traffic Barricades |                   |            |      |
| -- Plastic -- 100%         |                   |            |      |
|                            |                   |            |      |
| Plastic or Rubber Parking  |                   |            |      |
| Stops -- 100%              |                   |            |      |
|                            |                   |            |      |
| Concrete Parking Stops --  |                   |            |      |
| Must contain fly ash       |                   |            |      |
+----------------------------+-------------------+------------+------+

  -----------------------------------------------------------------------
  **For questions or additional information, contact Samuel McCord at
  505-845-7935 or by email at: <samccor@sandia.gov>**

  -----------------------------------------------------------------------

**Instructions for Affirmative Procurement Report**

1\. Determine if you purchased any of the materials in column 1 this
reporting period. You must report any purchases of this material,
whether or not the material contains recycled content

2\. Determine if the material contains the minimum recycled content.
Follow the link to the EPA website with more information about that
material.

3\. Point at desired box with cursor and click to fill in box.

4\. Enter the total purchase amount for the material (cost to Sandia).

5\. Enter the cumulative total for this material for this project.

6\. If you buy two or more lots of the same material and one contains
recycled content and one does not, please go to the Alternate Reporting
Section at the bottom of the page.

**This report must be filled out prior to submitting invoices for
payment. If it is not included with invoice, payment may be delayed**.

**[Definitions]{.underline}**

**Project Description:** The name of the project and/or the building \#
if applicable

**Project Start and End Date:** This is the start date and projected end
date for your company's work on this PO of this project.

**Reporting Period:** Please read your contract to determine your
reporting interval. Contact your Sandia Contract Representative if you
have any questions.

**Minimum Recycled Content:** The minimum amount of a recycled material
that must be included in the item purchased. This can be determined from
manufacturer's information on spec sheets or web sites.

**Steel:** The Environmental Protection Agency assumes that all steel
contains a minimum amount of 25% total recovered material due to market
conditions. As this is accomplished at the smelter, product
manufacturers may be unaware. Only be concerned if the manufacturer
makes a point of stating that their product contains 100% virgin
materials.

**Cumulative Total to Date:** The cumulative total should reflect the
total purchases for the project, whether or not they have recycled
content.

**Alternate Reporting Section**

If some but not all of a material meets recycled content requirements,
list the amount that met the requirements on the front pages and list
non-recycled content items here. For example, if you bought \$20,000 of
insulation, but only \$10,000 contained the minimum recycled content,
you would enter \$10,000 on Page One and \$10,000 here. [This ONLY
applies if some of the purchased material contains recycled content and
some does not.]{.underline}

  --------------------- --------------------- ----------------------------
  **Material Not        **Purchase Amount     **Reason Material was Not
  Meeting               (\$) this Period      Purchased with Recycled
  Requirements**        (Cost to Sandia)**    Content.**

                                                   

                                                   

                                                   

                                                   
  --------------------- --------------------- ----------------------------

**Other Material**: If you purchase recycled content material that is
not included in the table, well done! Please report it here.

  ------------------------- ---------------------------- ----------------
  **Material**              **Recycled Content**         **Total Dollar
                                                         Value**

                                                              

                                                              

                                                              
  ------------------------- ---------------------------- ----------------

[^1]: ^?^ <http://www.epa.gov/cpg/products/cement.htm>

[^2]: <http://www.epa.gov/cpg/products/flow-fil.htm>

[^3]: <http://www.epa.gov/cpg/products/building.htm>

[^4]: <http://www.epa.gov/cpg/products/paint.htm>

[^5]: <http://www.epa.gov/cpg/products/pipe.htm>

[^6]: <http://www.epa.gov/cpg/products/floor.htm>

[^7]: <http://www.epa.gov/cpg/products/shower.htm>

[^8]: <http://www.epa.gov/cpg/products/mats.htm>

[^9]: <http://www.epa.gov/cpg/products/roof.htm>

[^10]: <http://www.epa.gov/cpg/products/pallets.htm>

[^11]: <http://www.epa.gov/cpg/products/grit.htm>

[^12]: ^128^<http://www.epa.gov/cpg/products/drums.htm>

[^13]: <http://www.epa.gov/cpg/products/mulch.htm>

[^14]: <http://www.epa.gov/cpg/products/compost.htm>

[^15]: <http://www.epa.gov/cpg/products/ramps.htm>

[^16]: <http://www.epa.gov/cpg/products/bikes.htm>

[^17]: <http://www.epa.gov/cpg/products/signage.htm>

[^18]: <http://www.epa.gov/cpg/products/strappin.htm>

[^19]: <http://www.epa.gov/cpg/products/furniture.htm>

[^20]: <http://www.epa.gov/cpg/products/pk-bench.htm>

[^21]: <http://www.epa.gov/cpg/products/garden.htm>

[^22]: <http://www.epa.gov/cpg/products/fencing.htm>

[^23]: <http://www.epa.gov/cpg/products/fiberbrd.htm>

[^24]: <http://www.epa.gov/cpg/products/channel.htm>