5900-66 Qualified Product Information Form for Commercial Fryers

OMB Control No. 2060-0528

Approval Expires XX/XX/XX

United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

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Qualified Product Information Form for Commercial Fryers

Office of Atmospheric Programs

ENERGY STAR^® product information form for use by ENERGY STAR qualified commercial fryer partners (Companies who have joined ENERGY STAR for commercial fryers by signing a Partnership Agreement)

You may use this form to report only those products that are sold under the company’s brand name. If your firm sells its models to another company that uses its own brand name, that company must join ENERGY STAR and report its own products. Information from this form will be added to the list of ENERGY STAR qualified commercial fryers. Please copy this form and return one for each qualifying product model to the address provided below.

Company Name: _______________________ Product Contact Information__________________

(As listed in Partnership Agreement) (For public requesting product information)

Name: ___________________________

Tel:___________________

Fax:___________________

E-mail: ___________________________

Note: Please provide information on the tested model ONLY and complete all the fields below.

Brand Name/ Manufacturer	Model Name & Number	Fryer Size (inches)	Fuel Type*	Heavy Load (French Fry) Cooking Energy Efficiency (%)	Idle Energy Rate
					Gas (Btu/hr)	Electric (watts)

* Please indicate gas or electric

Date model available for purchase: _________________

Tested By: (Name of Independent Testing Firm or Self-Tested) _________________Date Tested: _____________

Note: testing must be done in accordance with ASTM Standard F1361-99.

Labeling Requirements

By checking the boxes below, you are confirming that you have reviewed and will meet the labeling requirements outlined in the ENERGY STAR Program Requirements for Commercial Fryers. These requirements include:

 On the product  In product literature  On Internet site

Please check one or more of the following international markets where these products are sold (if applicable)?

 Australia/New Zealand  Canada  EU  Japan  Mexico  Taiwan

Please submit your completed Qualified Product Information Forms one of the following ways:

E-mail QPI forms to ENERGY STAR for Commercial Fryers at commercialfoodservice@icfi.com.

Fax QPI forms to ENERGY STAR for Commercial Fryers at (202) 862-1144.

US Mail/Overnight/Express QPI forms to: ENERGY STAR for Commercial Fryers, 1725 Eye St. NW, Suite 1000, Washington, DC 20006.

The public reporting and recordkeeping burden for this collection of information is estimated to average 4.85 hours 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, 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 in any correspondence. Do not send the completed form to this address.

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ENERGY STAR, US EPA, 1200 Pennsylvania Ave., MC 6202J, Washington, DC 20460 USA

Toll-free number: 1-888-STAR-YES Web site: www.energystar.gov

EPA Form No. 5900-66