5900-452 Altitude Kit Summary Worksheet

Engine Manufacturer Name		Model Year
Engine Family Name	Altitude Kit Identification Number (Part Number)	Altitude Range (ft. above sea level)	Comments
AXYZ0025GGG	XYZ-123456789	3000 - 6000 ft.	Sample
AXYZ0025GGG	XYZ-123456790	6000 - 8000 ft.	Sample
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							This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2060-0338). Responses to this collection of information are mandatory (40 CFR 1054). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to be 1 hour 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 to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 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.
							OMB No. 2060-0338
							Approval Expires on
							1/31/2022
							EPA Form 5900-452