5900-89 Statement of Energy Performance - Plants

EPA's ENERGY STAR Program in the Commercial and Industrial Sectors (Renewal)

5900-89_Statement of Energy Performance - Plants

ENERGY STAR Program in the Commercial and Industrial Sectors - Private Sector Entities

OMB: 2060-0347

Document [doc]
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OMB Control No. 2060-0347



 


 

STATEMENT OF ENERGY PERFORMANCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Enter Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For 12-month period ending:

Enter Month/Day/Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Facility Address

 

Owner's Address

 

Corporate Energy Manager Contact

 

 

 

Enter Name

 

Owner's Name

 

Contact Name

 

 

 

 

Street Address

 

Street Address

 

Email Address

 

 

 

 

Address 2

 

Address 2

 

Phone Number

 

 

 

 

New York, NY

 

City, State

 

 

 

 

 

 

10000

 

ZIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Automobile Assembly Plant
Energy Performance Indicator

 

 

 

 

 

 

 

 

 

 

 

 

Energy Performance Score:

 

100

 

 

 

 

 

 

GHG Savings (Kg CO2e)

165

 

 

 

 

 

 

Energy Savings (MMBtu)

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Professional Verification

 

 

 

 

 

 

Professional Engineer Name

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

Address 2

 

 

 

 

 

 

 

 

City, State ZIP

 

 

 

 

 

 

 

 

Phone Number:

 

 

 

 

 

 

 

 

License Number:

 

 

 

 

 

 

 

 

Licensing State:

 

 

Professional Engineer Stamp

 

 

 

 

 

 

 

 

 

 

 

 

EPI Verification

 

 

 

Based on the conditions observed at the time of my visit to this facility, I certify that the information used in this tool to generate the energy performance score represented on this statement is accurate.

 

 

 


 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE:

 

 

 

 

 

 

 

 

1. Applications for certification of plant energy performance to the US EPA must be made within 4 months of Period Ending date. Award of the ENERGY STAR is not final until approved by the US EPA.

 

 

 

 

 

 

 

 

 

 

 

2. All energy performance scores and supporting data must first be verified by the US EPA or a US EPA-designated EPI reviewer if supporting data is considered to be proprietary before submitting applications for the ENERGY STAR.

 

 

 

 

 

 

 

 

 

 

 

3. An energy performance score of 75 is the minimum required score to be considered eligible for the ENERGY STAR.

 

 

 

 

 

 

 

 

 

 

 

4. Estimates of energy and CO2 emissions savings are provided to illustrate the difference between the benchmarked plant's energy use and estimated CO2 emissions as compared to "an average plant" that is defined as having an energy performance score at the 50th percentile.

The fuel mix used to estimate emissions data for the average plant is the same as for the benchmarked plant. These estimates are provided to assist plants with communicating their energy and environmental achievements.

 

 

 

 

 

 

 

 

 

 

 

For US EPA Use Only:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 




The public reporting burden for this collection of information is estimated to range up to 15 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 5900-89

File Typeapplication/msword
AuthorSaunders, Katie
Last Modified BySaunders, Katie
File Modified2016-01-22
File Created2016-01-22

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