5900-457 NR Small SI Equipment Worksheet

Small SI Equipment Manufacturer Certification

Manufacturer:

Equipment Family Name:

Projected Sales Volume:

Engine or Equipment Model

Exhaust Engine Family Name

Fuel Tank EPA Family Name

Fuel Line EPA Family Name

Manufacturer Comments

Paperwork Reduction Act Notice

The public reporting and recordkeeping burden for this collection of information is estimated to average 453.79 hours per respondent. 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 2060-0338 in any correspondence. Do not send the completed form to this address.