ENERGY STAR® Challenge for Industry Recognition Application
OMB Control Number 2060-0347
As the energy manager for my company and/or site, I am writing to nominate the following site for recognition for achieving the ENERGY STAR Challenge for Industry.
I affirm that this site meets the conditions necessary to qualify for the ENERGY STAR Challenge for Industry recognition by achieving a10% reduction in energy intensity within 5 years of establishing a baseline.
I have personally examined and am familiar with the information contained in the Statement of Energy Improvement. The information is based on reasonable inquiry and is, to the best of my knowledge, true, accurate, and complete. I have no reason to believe the site would not meet all EPA program requirements for receiving the ENERGY STAR Challenge for Industry recognition.
I understand the U.S. Environmental Protection Agency reserves the right to request and review any records which support the data used to calculate the energy intensity reduction for this site. I also certify that I am maintaining a file on this site in accordance with the ENERGY STAR Challenge for Industry data management requirements. Furthermore, I agree to associate the achievement of the ENERGY STAR Challenge for Industry only with the aforementioned site and to adhere to the ENERGY STAR Identity Guidelines.
IMPORTANT: Upon completing this online application form, you must submit the site's original, signed Statement of Energy Improvement by courier service (do not send via US Postal Service) to Rebecca Hindin, ENERGY STAR, U.S. Environmental Protection Agency, 1310 L Street, NW, Room 913L, Washington, DC 20005 to complete the application process.