5900-265 EPI Award Specification Sheet

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

5900-265_Plant Award Specification Sheet

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

OMB: 2060-0347

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OMB Control No. 2060-0347

Date



Plant name as it will appear on Certificate



Company name as it will appear on Certificate




Corporate energy manager contact information

Name



Title



Organization



Address 1

Address 2



City



State



Zip code



Email



Phone




Organization/Plant Owner’s Chief Executive Officer information:

Name



Title



Organization



Address 1

Address 2



City



State



Zip code



Email



Phone







Professional Engineer information

Name



Title



Organization



Address 1

Address 2



City



State



Zip code



Email



Phone



License number




Plant Owner information:

Company or Parent Company Name



Address 1

Address 2



City



State



Zip code



Web address:



Phone





NOTE: Unless specified otherwise, all recognition materials (the bronze plaque, the banner/flag graphic, and the letter of congratulations) will be addressed to and sent to the Corporate Energy Manager at the location specified above. The letter of congratulations for the CEO will be sent directly to the address provided for the CEO.



Please specify any other information/requests for distribution of recognition materials in the space below.


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 5900-265



File Typeapplication/msword
File TitleService/Product Provider
File Modified2012-11-08
File Created2008-03-05

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