DOE F 220.42 Commerical Gas and Oil Fired Storage Water Heaters

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Overview

Certification
Input
Product Group Codes

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Sheet 1: Certification

OMB Control Number: 1910-1400 (Expiration Date: XXXXXX XX, XXXX)

Version 5.4

DOE F 220.42

Commercial Gas-Fired and Oil-Fired Storage Water Heaters

Product Type:

Commercial Gas-Fired and Oil-Fired Storage Water Heaters

Status of This Certification Sheet

No Data

5.4

Overall Status of Template

No Data

Click here for instructions for completing this form

Each Importer and U.S. Manufacturer is legally required to certify the compliance of the products it imports, produces, assembles or manufactures. This party is the "Certifier" on this form. This certification may be submitted by the Importer or U.S. manufacturer or by a Third Party Representative. This party is the "Submitter" on this form.

Certifier - Party Legally Obligated to Certify Compliance

Submitter - Party Submitting This Report

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The party submitting this report is (select one only):

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Certifier Contact Information

Third Party Representative Contact Information, if Applicable

Full Legal Name of Individual

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Full Legal Name of Individual

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Full Legal Name of Company

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Full Legal Name of Company

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Complete Company Mailing Address

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Complete Company Mailing Address

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Phone Number

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Phone Number

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Email Address

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Email Address

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Compliance Statement

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Submitter Signature (Type your Full Legal Name)

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Date (MM/DD/YYYY)

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OMB Control Number: 1910-1400 (Expiration Date: XXXXXX XX, XXXX)

Paperwork Reduction Act Statement

OMB Burden Disclosure Statement

This data is being collected for manufacturers to certify compliance to DOE's energy conservation, water conservation, or design standards. The data you supply will be used by the Department to monitor compliance with the energy conservation, water conservation, and design standards and testing requirements for the consumer products and commercial and industrial equipment mandated by the Energy Policy and Conservation Act, as amended. Public reporting burden for this collection of information is estimated to average 35 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Records Management Division, IM-23, Paperwork Reduction Project (1910-1400), U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (1910-1400), Washington, DC 20503. Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number. Submission of this data is mandatory.

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Sheet 2: Input

Commercial Gas-Fired and Oil-Fired Storage Water Heaters	Commercial Gas-Fired and Oil-Fired Storage Water Heaters								Version 5.4		· Please enter your data in the columns shaded in gray below, using a separate line for each model. · Click on the column heading for instructions on how to complete cells in that column. · Cells highlighted in yellow indicate an "Error." "Error" means that information is missing or there is an issue with the entry. · If the "Status" for a row is "Error," you can see an explanation in the columns to the far right.
5.4
	Status of This Input Sheet		No Data		Overall Status of Template		No Data
	Certification Report			Click here for instructions for completing this form																									The cells below provide an explanation for "Errors".					The cells below provide an explanation for "Errors".			The cells below provide an explanation for "Errors".				The cells below provide an explanation for "Errors".				The cells below provide an explanation for "Errors".				The cells below provide an explanation for "Errors".				The cells below provide an explanation for "Errors".
Line No.	Status	Manufacturer	Brand Name(s)	Basic Model Number	Enter Information in Only One of the Two Columns in Each Row		Action	Product Group Code	Sample Size (Number of Units Tested)	Is the Certification for this Basic Model Based on a Waiver of DOE's Test Procedure Requirements?	Date of Test Procedure Waiver, if Applicable	Is the Certification based upon any Exception Relief from an Applicable Standard by DOE's Office of Hearing and Appeals?	Date of Exception Relief, if Applicable	Is Certification Based on the use of an Alternative Efficiency Determination Method (AEDM)?	Name of AEDM (If Applicable)	Measured or Rated Storage Volume (gallons) (As Applicable)	For Commercial Gas-Fired and Oil-Fired Storage Water Heaters other than Residential-Duty Basic Models, Complete the Applicable Cells Below								For Residential-Duty Commercial Gas-Fired and Oil-Fired Storage Water Heaters, Complete the Cells Below				Manufacturer Status	Brand Name(s) Status	Basic Model Number Status	Individual Model Number Covered by Basic Model Status	Private Model Number Covered by Basic Model Status	Action Status	Product Group Code Status	Sample Size (Number of Units Tested) Status	Is the Certification for this Basic Model Based on a Waiver of DOE's Test Procedure Requirements? Status	Date of Test Procedure Waiver, if Applicable Status	Is the Certification based upon any Exception Relief from an Applicable Standard by DOE's Office of Hearing and Appeals? Status	Date of Exception Relief, if Applicable Status	Is Certification Based on the use of an Alternative Efficiency Determination Method (AEDM)? Status	Name of AEDM (If Applicable) Status	Measured or Rated Storage Volume (gallons) (As Applicable) Status	Commercial Gas-Fired and Oil-Fired Storage Water Heaters other than Residential-Duty Basic Models								For Residential-Duty Commercial Gas-Fired and Oil-Fired Storage Water Heaters
					Individual Model Number Covered by Basic Model	Private Model Number Covered by Basic Model											Does the Manufacturer Elect the Witness Test Option for Verification Testing? (If Applicable)	Is the Tank Surface Area Thermally Insulated to at Least R-12.5? (If Applicable)	Is a Standing Pilot Light Used? (If Applicable)	Does the Basic Model Have a Flue Damper or Fan-Assisted Combustion? (If Applicable)	Thermal Efficiency (%)	Standby Loss (Btu/hour) (If Applicable)	Rated Input (Btu/hour) (If Applicable)	Supplemental Testing Instructions PDF Filename (Optional)	Uniform Energy Factor (UEF)	First Hour Rating (gal)	Recovery Efficiency (%)																	Does the Manufacturer Elect the Witness Test Option for Verification Testing? (If Applicable) Status	Is the Tank Surface Area Thermally Insulated to at Least R-12.5? (If Applicable) Status	Is a Standing Pilot Light Used? (If Applicable) Status	Does the Basic Model Have a Flue Damper or Fan-Assisted Combustion? (If Applicable) Status	Thermal Efficiency (%) Status	Standby Loss (Btu/hour) (If Applicable) Status	Rated Input (Btu/hour) (If Applicable) Status	Supplemental Testing Instructions PDF Filename (Optional) Status	Uniform Energy Factor (UEF) Status	First Hour Rating (gal) Status	Recovery Efficiency (%) Status
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Sheet 3: Product Group Codes

The following is a description of each product group code:
Product Group Code	Product Group Code Description	Draw Pattern
1	Commercial Gas-Fired Storage Water Heaters with Input Capacity of 155,000 Btu/hr or Less and Storage Capacity of 140 Gallons or Less
2	Commercial Gas-Fired Storage Water Heaters with Input Capacity of 155,000 Btu/hr or Less and Storage Capacity of Greater than 140 Gallons
3	Commercial Gas-Fired Storage Water Heaters with Input Capacity Greater than 155,000 Btu/hr and Storage Capacity of 140 Gallons or Less
4	Commercial Gas-Fired Storage Water Heaters with Input Capacity Greater than 155,000 Btu/hr and Storage Capacity of Greater than 140 Gallons
5	Commercial Oil-Fired Storage Water Heaters with Input Capacity of 155,000 Btu/hr or Less and Storage Capacity of 140 Gallons or Less
6	Commercial Oil-Fired Storage Water Heaters with Input Capacity of 155,000 Btu/hr or Less and Storage Capacity of Greater than 140 Gallons
7	Commercial Oil-Fired Storage Water Heaters with Input Capacity Greater than 155,000 Btu/hr and Storage Capacity of 140 Gallons or Less
8	Commercial Oil-Fired Storage Water Heaters with Input Capacity Greater than 155,000 Btu/hr and Storage Capacity of Greater than 140 Gallons
9	Residential-Duty Commercial Gas-Fired Storage Water Heaters with Input Capacity Greater than 75,000 Btu/hr or Less than or Equal to 105,000 Btu/hr and Storage Capacity of 120 gallons or Less	Very Small
10	Residential-Duty Commercial Gas-Fired Storage Water Heaters with Input Capacity Greater than 75,000 Btu/hr or Less than or Equal to 105,000 Btu/hr and Storage Capacity of 120 gallons or Less	Low
11	Residential-Duty Commercial Gas-Fired Storage Water Heaters with Input Capacity Greater than 75,000 Btu/hr or Less than or Equal to 105,000 Btu/hr and Storage Capacity of 120 gallons or Less	Medium
12	Residential-Duty Commercial Gas-Fired Storage Water Heaters with Input Capacity Greater than 75,000 Btu/hr or Less than or Equal to 105,000 Btu/hr and Storage Capacity of 120 gallons or Less	High
13	Residential-Duty Commercial Oil-Fired Storage Water Heaters with Input Capacity Greater than 105,000 Btu/hr or Less than or Equal to 140,000 Btu/hr and Storage Capacity of 120 gallons or Less	Very Small
14	Residential-Duty Commercial Oil-Fired Storage Water Heaters with Input Capacity Greater than 105,000 Btu/hr or Less than or Equal to 140,000 Btu/hr and Storage Capacity of 120 gallons or Less	Low
15	Residential-Duty Commercial Oil-Fired Storage Water Heaters with Input Capacity Greater than 105,000 Btu/hr or Less than or Equal to 140,000 Btu/hr and Storage Capacity of 120 gallons or Less	Medium
16	Residential-Duty Commercial Oil-Fired Storage Water Heaters with Input Capacity Greater than 105,000 Btu/hr or Less than or Equal to 140,000 Btu/hr and Storage Capacity of 120 gallons or Less	High