Form 590-124 Marine CI & IMO Certification Application

Stage 1 Review PERSON & DATE

Date Received

Email notification to MAN

Certificate Status

Reviewer

Printed to AA

Email to processor

Sent to Database

CERT #

CATALOG #

Manufacturer:
Manuf Type:

View
Queue

View
Cert

Check
Sheet

Main
Menu

Database
Family Info
Certificate Requested:

OEM

Print
Record

EPA

IMO

POST-MANUFACTURE

Engine Type:
Model Year:
Engine Family:

1. EPA Fee paid?:
Yes
2. EPA Fee paid date:
3. Certification Class:
4. Process Code:
5. Carry over:
If yes, list the previous family:
6.Send the certificate to:
Name
Title
Company
Address

No

14. Liters per cylinder, HP rating, and Category:

Change of Address
Official Cert. Rep?

< 0.9 liters/cyclinder, 37 kw or greater (Category 1)
>= 0.9 --> <1.2,
all ratings
(Category 1)
>= 1.2 --> <2.5,
all ratings
(Category 1)
>= 2.5 --> <5.0,
all ratings
(Category 1)
>= 5.0 --> <15.0, all ratings
(Category 2)
>= 15.0 --> <20.0, rating <3300 kw
(Category 2)
>= 15.0 --> <20.0, rating >= 3300 kw (Category 2)
>= 20.0 --> <25.0, all ratings
(Category 2)
>= 25.0 --> <30.0, all ratings
(Category 2)
>= 30.0
(Category 3)

15. Method Of Aspiration:
16. Usage Of Engine:
17. Projected Sales:

Phone
Fax
Email

18. Estimated
Production Period:

7. Manuf Family Name:
8. Engine Cycle:
9. Number of Cylinders:
10. Cylinder Configuration:
11.Emission Cont. system:1.
2.
3.

outside CA
inside CA
Total
Start
End

19. Plant contact name:

20. Plant Location:
Name and street address:

Country:

12. Fuel Type:
13. Fuel System Type :

22. NTE

Diagn
21. Averaging, Banking, and Trading:
Averaging Banking, and Trading?

FEL's:
THC+NOx
PM

1

Yes

No

[FELs must be in g/kW-hr]

This engine family complies with the following NTE :

NTE explanation, if necessary

1.2 X STD
1.5 X STD
1.25 X STD
Other
N/A

23. Confidential Business Information (CBI):
CBI Until
Introduction into
Commerce

24. General Comments:

CBI Indefinitely

Family Information

2

Stage 1 Review PERSON & DATE

Date Received

Email notification to MAN

Certificate Status

Reviewer

Printed to AA

Email to processor

Sent to Database

CERT #

CATALOG #

View
Queue

Database
Test Info

Manufacturer:
Manuf Type:

Certificate Requested:
OEM

EPA

IMO

POST-MANUFACTURE

Engine Type:
Model Year:

This record may contain CBI information

Engine Family:

1. Test Data Set:
2. Engine Code:
3. Engine Model:
4. Number of Cylinders:
5. Displacement per cylinder:
6. Engine I.D. Number:
7. Rated Power(kW)
@ Rated RPM:
8. Torque (NM) @
Intermediate Engine
RPM:

13. Official Test Results

9. Certification Fuel:
10. Location of Testing:

D

11. Test cycle:
If Special or Alternate,
give discription:

@

@ 12. Useful life period
Useful life explanation,
if necessary

All results must be in g/kW-hr

Date:
Test 1

Test 2

Test 3

14. Deterioration Factors,
if applicable

Total Hydrocarbon
NOx
PARTICULATE
CARBON MONOXIDE

15. Certification Levels
(Deteriorated Test Results)
All results must be in g/kW-hr

STDs

FELs

Fill in the appropriate standard or NOx limit

NOx only Tier 1 or IMO
Total Hydrocarbon + NOx
PARTICULATE
CARBON MONOXIDE

3

16. NOx Reducing Device?:

Yes

No

18. CBI:

IMO only

Test
Info.

17. Is the Parent Engine base on highest NOx?:
IMO only

Yes

No

If NO, specify criteria for
selection of Parent Engine:

4

CBI Until

CBI Indefinitely

Stage 1 Review PERSON & DATE

Date Received

Email notification to MAN

Certificate Status

Reviewer

Printed to AA

Email to processor

Sent to Database

CERT #

CATALOG #

View
Queue

Database
Model Info.

Manufacturer:
Manuf Type:

Certificate Requested:
OEM

EPA

IMO

POST-MANUFACTURE

Engine Type:
This record may contain CBI information

Model Year:
Engine Family:
5.Fuel Rate:

1.Engine
Code

6.Fuel Rate:

8.Fuel Rate:

9.Fuel Rate:

2.Engine
3.Dis- 4. KW@RPM mm/stroke
(lbs/hr)
7.Torque @ RPM mm/stroke@ (lbs/hr)@peak
Model placement (SAE Gross) @ peak kW-hr @ peak kW-hr
(SEA Gross)
peak torque
torque

9

10. CBI:

CBI Until
Introduction into
Commerce

CBI Indefinitely

Model Information

10

Stage 1 Review PERSON & DATE

Date Received

Email notification to MAN

Certificate Status

Reviewer

Printed to AA

Email to processor

Sent to Database

CERT #

CATALOG #

Database

View
Queue

Parts Info.

Manufacturer:
Manuf Type:

Certificate Requested:
OEM

EPA

IMO

POST-MANUFACTURE

Engine Type:

This record may contain CBI information

Model Year:
Engine Family:

1.Engine
Code

2.Engine
Model

3. Injection
Pump
4. Injector 5. Turbo Charger

6. Electronic
7. After
Control
Treatment Device
Module
(Specify)

11

1.Engine

2.Engine

Additional Part Names and Numbers for emission related parts

8. After Cooler

Blank
for ad

Stage 1 Review PERSON & DATE

Date Received

Email notification to MAN

Certificate Status

Reviewer

Printed to AA

Email to processor

Sent to Database

CERT #

CATALOG #

View
Queue

Database
Tech.Desc.

Manufacturer:
Manuf Type:

Certificate Requested:
OEM

EPA

IMO

POST-MANUFACTURE

Engine Type:
Model Year:

This record may contain CBI information

Engine Family:

1. Adjustable Parameters:
Parameter(s)

Dia
Adjustable Range (or NA)

Tamper Resistance Method (or NA)

2. Auxillary Emission Control Device (AECD), if applicable:
AECD Name

5

3. Engine Sensor Information and Software Control, if applicable:

Does the AECD reduce the
effectiveness of the
emission control system?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No

AECD(s) Used

Outputs controlled by that input:

Sensed Parameter

4. Technical Description:

-Basic e
-Fuel sy
-Ingnitio
-Intake s
-Emissi
-Auxilla
-exhaus

6
5. Confidential Business Information:
CBI Until

CBI Indefinitely

Introduction into
Commerce

Technical Information

6. Injection Timing Maps - Insert copies in container field (Right-click, Insert Object, then navigate to the file)

1

2

3

4

5

6

7. Diagrams/Nox technical file (IMO), pdf files, etc. - Insert copies in container field (Right-click, Insert Object, then navigate to
2. Diagrams/ Drawings/Schematics:

1. Diagrams/ Drawings/Schematics:

7
3. Diagrams/ Drawings/Schematics:

4. Diagrams/ Drawings/Schematics:

Stage 1 Review PERSON & DATE

Date Received

Email notification to MAN

Certificate Status

Reviewer

Printed to AA

Email to processor

Sent to Database

CERT #

CATALOG #

Database
IMO Info.

Manufacturer:
Manuf Type:

Certificate Requested:
OEM

EPA

IMO

POST-MANUFACTURE

Engine Type:
Model Year:

This record may contain CBI information

Engine Family:

Dia

Particulars of the engine
1. Name & Address of the manufacturer:

5. Date of pre-certification survey:

6. Technical file identification number:
2. Place of engine build:

7. On-board NOx verification procedures identification number:

8. Models covered by the parent engine:
3. Date of engine build:

4. Place of pre-certification survey:

9. Confidential Business Information:
CBI Until
Introduction into
Commerce

CBI Indefinitely

IMO Information

13

Statement of Compliance

Certification Team Leader
Engine Compliance Programs Group
U.S. Environmental Protection Agency
Mail Code: 6403-J
Washington, DC 20460
Dear Certification Team Leader:

Sincerely,