5900-68 Qualified Product Information Form for Commercial Solid

OMB Control No. 2060-0528

Approval Expires XX/XX/XX

United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

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Qualified Product Information Form for

Commercial Solid Door Refrigerators and Freezers

Office of Atmospheric Programs

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Energy Star^ product information form for use by Energy Star qualified commercial solid door refrigerators and freezers partners (Companies who have joined Energy Star for commercial solid door refrigerators and freezers by signing the Partnership Agreement)

You may use this form to report only those products that are sold under your company’s brand name. If your firm sells its models to another company that uses its own brand name, that company must join the program and report its own products. Information from this form will be added to the list of Energy Star qualified Commercial Solid Door Refrigerators and Freezers products. Please send this form for each qualifying product model to Energy Star for Commercial Solid Door Refrigerators and Freezers via fax at (202) 862-1144 or email [email protected].

Product Contact Information

Company Name:__________________________________ (For public requesting product information)

(As listed in Partnership Agreement)

Name: ______________________________________

Tel:___________________ Fax:_________________

E-mail: _____________________________________

Note: Please provide the following information on the tested model ONLY.

Please complete all the fields below (see term definitions on page 2).

Brand Name/ Manufacturer	Model Name & Number	Product Type	Number of Doors	Cabinet Type	Defrost Type	Internal Volume (cu ft)
						Refrigerator	Freezer	Total

External Dimensions (in and cm)						Daily Energy Consumption (kW-hrs/day)	Refrigerant Type	Date Product First Shipped
Height		Width		Depth
in:	cm:	in:	cm:	in:	cm:

Tested By: (Name of Independent Testing Firm or Self-Tested) _____________________ Date Tested: _______________

Per the requirements in the Energy Star Partnership Agreement, has the label been placed:

__ in product literature? __ on your Internet site where the product information is displayed?

__ on product packaging? __ on the top/front of the product?

Qualification

This model meets all the requirements of the ENERGY STAR Commercial Solid Door Refrigerators and Freezers Agreement. (See Eligibility Criteria section of the ENERGY STAR Commercial Solid Door Refrigerators and Freezers Partnership Agreement)

Please sign below:

Signature_________________________________________ Date__________

Printed Name______________________________________

Term Definitions

Product Type

Products included as commercial refrigerators and freezers are refrigerator, freezer, or combination refrigerator-freezer with self-contained condensing systems for storing food products or other perishable items at specified temperatures and designed for use by commercial or institutional facilities. Product types are defined as follows:

Commercial Refrigerator: A cabinet designed for storing food or other perishable items at temperatures above 32ºF and below 40ºF.

Commercial Freezer: A reach-in cabinet designed for storing food or other perishable items at temperatures below 0ºF and above -5ºF.

Commercial Refrigerator-Freezer: A cabinet with two or more compartments, at least one of which is designed for storing food or other perishable items at temperatures above 32ºF and below 40ºF and at least one of which is designed for storing food or other perishable items at temperatures below 0ºF and above -5ºF.

Ice Cream Freezer: A commercial cabinet designed for storing food or other perishable items at temperatures below -5ºF.

Cabinet Type

Cabinet type included under commercial refrigerators and freezers are:

Reach-in Cabinet: An upright commercial refrigeration cabinet with hinged, solid doors but excluding undercounter, roll-in, roll-through, or pass-through cabinets.

Undercounter Cabinet: An upright commercial refrigeration cabinet without a worktop surface which has hinged, solid doors and which is intended for installation under a counter.

Roll-in or Roll-through Cabinet: An upright commercial refrigeration cabinet with hinged, solid doors that allows wheeled racks of product to be rolled into or through the refrigerator or freezer.

Pass-through Cabinet: An upright commercial refrigeration cabinet with hinged, solid doors on both the front and rear of the refrigerator or freezer.

Defrost Type

Defrost types include automatic, manual, and partial automatic.

Internal Volume

The internal volume of the cabinet in cu. ft. determined according to American National Standards Institute/Association of Home Appliance Manufacture ANSI/AHAM HRF-1-2004.

Daily Energy Consumption

The daily energy consumption is to be measured using The American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc. (ASHRAE) Standard 117-1992, “Method of Testing Closed Refrigerators.” The energy consumption shall be reported in kW-hours/day.

The public reporting and recordkeeping burden for this collection of information is estimated to average 4.85 hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

Energy Star, US EPA, 1200 Pennsylvania Avenue, MC 6202J, Washington, DC 20460 USA

Toll-free number 1-888-STAR-YES; Web site http://www.energystar.gov

EPA Form No. 5900-68