5900-69 Qualified Product Information Form for Commercial Steam

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 Steam Cookers

Office of Atmospheric Programs

­ENERGY STAR^® product information form for use by ENERGY STAR commercial steam cooker partners (Companies who have joined ENERGY STAR for commercial steam cookers by signing a Partnership Agreement)

You may use this form to report only those products that are sold under the company’s brand name. If your firm sells its models to another company that uses its own brand name, that company must join ENERGY STAR and report its own products. Information from this form will be added to the list of ENERGY STAR qualified commercial steam cookers. Please copy this form and return one for each qualifying product model to the address provided below.

Product Contact Information

Company Name:______________________________ (For public requesting product information)

(As listed in Partnership Agreement)

Name: ___________________________

Tel:___________________

Fax:___________________

E-mail: ___________________________

Note: Please provide information on the tested model ONLY and complete all the fields below.

Brand Name/ Manufacturer	Model Name & Number	Product Type*	Steamer Technology**	Pan Capacity	Fuel Type***

* Pressure vs. pressureless

** Choose from boiler-based, steam-generator, or boilerless (“connectionless”)

*** Please indicate gas or electric

Idle Energy Rate		Heavy Load (Potato) Cooking Energy Efficiency (%)
Gas (Btu/hr)	Electric (watts)

Date model available for purchase: _____________

Tested By: (Name of Independent Testing Firm or Self-Tested) _________________Date Tested: _____________

Note: testing must be done in accordance with ASTM Standard F1484-99.

Labeling Requirements

By checking the boxes below, you are confirming that you have reviewed and will meet the labeling requirements outlined in the ENERGY STAR Program Requirements for Commercial Steam Cookers. These requirements include:

• On the product  In product literature  On Internet site

Please check one or more of the following international markets where these products are sold (if applicable)?

 Australia/New Zealand  Canada  EU  Japan  Mexico  Taiwan

Please submit your completed Qualified Product Information Forms one of the following ways:

E-mail QPI forms to ENERGY STAR for Commercial Steam Cookers at commercialfoodservice@icfi.com.

Fax QPI forms to ENERGY STAR for Commercial Steam Cookers at (202) 862-1144.

US Mail/Overnight/Express QPI forms to: ENERGY STAR for Commercial Steam Cookers, 1725 Eye St. NW, Suite 1000, Washington, DC 20006.

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.

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ENERGY STAR, US EPA, 1200 Pennsylvania Ave., MC 6202J, Washington, DC 20460 USA

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

EPA Form No. 5900-69