OMB Control No. 2060-0347
Ms. Rebecca Hindin
National Program Manager
ENERGY STAR
U.S. Environmental Protection Agency
1310 L Street, NW (Room 913L)
Washington, DC 20005
Dear Ms. Hindin:
As the corporate energy director for [name of company], I am writing to nominate the following plant for award of the (Date) ENERGY STAR:
[Plant name]
[Plant street address]
[Plant city, state, zip code]
As documented by the attached Statement of Energy Performance, I affirm that the aforementioned plant meets the conditions necessary to qualify for the ENERGY STAR, including:
Energy performance in the top 25 percent of similar existing plants, indicated by a minimum rating of 75 out of 100 as determined through the most current version of the ENERGY STAR plant energy performance indicator tool for this type of plant; and,
Safe lighting levels that meet the Illuminating Engineering Society of North America (IESNA) recommended best practices for industrial facilities as described in IESNA Lighting Handbook; 9th Edition, Chapter 19.
An objective assessment of the facility’s environmental record has been conducted as described in U.S. Environmental Protection Agency’s (EPA) Instructions for Applying for the ENERGY STAR.
I have personally examined and am familiar with the information contained in this Application. The information is based on reasonable inquiry and is, to the best of my knowledge, true, accurate, and complete. I have no reason to believe the plant would not meet all EPA program requirements for receiving the ENERGY STAR.
I am submitting this application within 4 months of the Period Ending Date on the enclosed Statement of Energy Performance. I understand EPA reserves the right to request and review any records which support the data used to produce the energy performance rating for this plant. I also certify that I am maintaining a file on this plant in accordance with EPA’s file maintenance guidelines. Furthermore, I agree to associate the ENERGY STAR name and logo only with the aforementioned plant and to adhere to ENERGY STAR’s Identity Guidelines.
Sincerely,
Signature__________________________
Signatory Name (Corporate Energy Manager for [Company name]):_________________
Facility Owner:_________________________
Attachments: Statement of Energy Performance, EPI Printout, Award Specification Sheet, Compliance Check Worksheet
The public reporting burden for this collection of information is estimated to range up to 10 minutes 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.
EPA Form 5900-264
| File Type | application/msword |
| File Title | Date |
| Author | owner |
| File Modified | 2012-11-08 |
| File Created | 2008-02-27 |