5900-169 Qualified Product Information Form for Commercial Dishwa

OMB No. 2060-0528
Approval Expires 03/31/2011
United States

ENVIRONMENTAL PROTECTION AGENCY
Washington, DC 20460
Qualified Product Information Form for Commercial Dishwashers
Office of Atmospheric Programs
ENERGY STAR® Qualified Product Information (QPI) Form for use by ENERGY STAR Commercial Dishwashers Partners
(Companies who have joined ENERGY STAR for Commercial Dishwashers by signing the Partnership Agreement).
Information from this form will be added to the list of ENERGY STAR Qualified Commercial Dishwashers on the ENERGY
STAR Web site at www.energystar.gov.
Note: Partners may use this QPI form to report only those products that are sold under the company’s brand name. If
your company sells its equipment to another company that uses its own brand name, that company must join ENERGY
STAR and report its own models. Please copy this form and return one for each qualifying model to the address or fax
number provided in Section VI, below.

I

Contact Information

Company Name: (as listed in the PA)

Name of Person Submitting Information:
Tel:

Fax:

E-mail:

II Qualifying Model Information
Brand

Model Name

Model Number

Machine Type*

Sanitation Method
(high or low temp)**

Date Available on Market

* Indicate undercounter, single-tank door-type, single tank conveyor, or multiple tank conveyor. Single tank door-type category includes
pot, pan, and utensil machines.
** For machines that are convertible between high and low temperature operation manufacturer should indicate as “high and low” and
can provide both sets of performance results in Section III, below. These machines must meet both high and low temperature
performance requirements to earn the ENERGY STAR.

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. 5900-169
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OMB No. 2060-0528
Approval Expires 03/31/2011

III Energy and Water Efficiency Performance
Idle Energy Rate (kW)*

Volume of Tank(s)**
Wash
Rinse

Water Consumption
(GPR)***

* Results should represent tank heater idle energy rate rounded to 2 significant digits.

** Manufacturers submitting multiple tank conveyors must provide wash and rinse tank data.

***To determine gallons per rack (GPR), manufacturers must use the calculations provided in Section 3 of the ENERGY STAR

specification. GPR results should be rounded to 3 significant digits.

IV Testing Requirements
Tested by: (Name of Independent Testing Firm or Self Tested)
Date Tested:

NSF Certification
Certification to NSF/ANSI 3 (yes/no):

Listed in NSF database (yes/no):

If not, please provide the following additional information (as applicable to each machine type):

Undercounter and Door-Type Machines:
Gallons per Hour

Wash Time

Rinse Time

Dwell Time

Load Time

Conveyor Machines:
Gallons per Hour

Rack Length

Conveyor Speed

Test Procedures
Testing must be done in accordance the following test standards:
Water Consumption:
• NSF/ANSI 3-2007 Standard, Commercial Warewashing Equipment.
Energy Consumption:
• ASTM Standard F1696, Standard Test Method for Energy Performance of Single-Rack Hot Water Sanitizing, DoorType Commercial Dishwashing Machines
• ASTM Standard F1920, Standard Test Method for Energy Performance of Rack Conveyor, Hot Water Sanitizing,
Commercial Dishwashing Machines

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. 5900-169
2

OMB No. 2060-0528
Approval Expires 03/31/2011

V Labeling Requirements
By checking the items below, you are confirming that you have reviewed and will meet the labeling requirements outlined

in the ENERGY STAR Program Requirements for Commercial Dishwashers. These requirements include:

____ On Top/Front of Product

____ In Product Literature

____On Product Packaging ____ On Internet Site

If answer to any of the above is no, explain why:

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

VI Contact Information
Please submit your completed QPI Forms in one of the following ways:
E-mail: [email protected]
Fax: (202) 862-1144 c/o Rebecca Duff, ICF International
US Mail/Overnight Express: Rebecca Duff, ICF International, 1725 Eye Street 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.

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. 5900-169
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