<p>Facility Name: Contact at Facility:</p><p>Facility Contact Phone/Email: Date: </p><p>Product Name Manufacturer Supplier Amount Used/ Month Dilutio Comments on Product n Rate (RTU=1 :1) Restroom Floors (Non-Sanitizing) </p><p>Restroom Floors (Sanitizing)</p><p>Restroom Fixtures</p><p>Toilet Bowl Cleaners</p><p>Disinfections Against Bloodborne Pathogens</p><p>Kitchen Countertops</p><p>Kitchen Sanitizers (Food Contact)</p><p>Product Name Manufacturer Supplier Amount Used/ Month Dilutio Comments on Product n Rate (RTU=1 :1) Air Freshener/Deodorizer</p><p>Laundry Sanitizer/Whitener</p><p>Hand soap (Antibacterial and Non-antibacterial)</p><p>General Purpose Cleaner (Non-disinfecting)</p><p>Floors (Non-Restroom)</p><p>Carpet Cleaner/Stain Remover</p><p>Other (including Specialty Applications)</p><p>Thank you for your commitment to creating a healthy school for students and staff! For more information, contact: Timothy Ballard, Director, Maintenance and Inspections, [email protected] Joanna Pi-Sunyer, Green Schools Coordinator, [email protected]</p>