| In-Use Testing |
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| Manufacturer Data Submission Template |
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OMB Control No. 2060-0321 |
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In-Use Test Information |
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Expiration Date XXXXXXXX |
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Manufacturer: |
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Test Mfr |
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Engine Family: |
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4PQAL3.00AAA |
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In-Use Test Contact: |
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Test Contact |
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Engine Category: |
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Large SI |
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Email Address: |
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test@test.com |
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Min. Tests Required: |
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4 |
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Phone #: |
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555-555-5555 |
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Start Date: |
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FEL/ Emission Limit(s) |
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Lab Test or Field Test? |
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Field Test |
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NOx+NMHC |
4.10 |
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PM |
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Comments: |
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This is an example In-Use Test report. |
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Engines Disqualified |
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and reason |
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Reason for |
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Non-compliance |
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In-Use Engine Test Results |
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Interim Calculations |
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Engine |
Service |
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Diagnostic |
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NOx / |
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NOx / |
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Engine |
Serial |
Build |
Accum |
Test |
Test |
System |
Test |
NMHC+NOx |
PM |
CO |
NMHC+NOx |
PM |
CO |
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Model |
Number |
Date |
Hours |
Date |
Time |
Functioning? |
Invalid? |
Result |
Result |
Result |
Mean |
Mean |
Mean |
Adjustment, Modifications, and Repairs |
Invalid Reason |
Additional Comments |
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1 |
C30 |
04-100 |
4/1/04 |
300 |
4/1/05 |
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yes |
no |
3.20 |
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3.20 |
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2 |
C30 |
04-101 |
4/1/04 |
450 |
4/5/05 |
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yes |
no |
3.60 |
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3.40 |
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intake manifold replaced with OEM parts. |
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3 |
C31 |
04-200 |
7/31/04 |
390 |
4/5/05 |
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yes |
no |
2.90 |
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3.23 |
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4 |
C31 |
04-201 |
8/12/04 |
550 |
4/5/05 |
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yes |
no |
3.30 |
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3.25 |
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5 |
C31 |
04-202 |
8/12/04 |
500 |
4/6/05 |
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yes |
no |
3.30 |
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3.26 |
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comments |
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6 |
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7 |
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8 |
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9 |
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10 |
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11 |
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12 |
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13 |
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14 |
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Current In-Use Test Status |
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Average |
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Number of Tests Performed: |
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5 |
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Pollutant |
Result |
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Number of Tests Required: |
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4 |
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NOx |
3.26 |
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PM |
NA |
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Status |
PASS |
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CO |
NA |
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| EPA Form No. 5900-93 |
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| The public reporting and recordkeeping burden for this collection of information is estimated |
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| to average 21 hours per response. Send comments on the Agency's need for this information, |
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| the accuracy of the provided burden estimates, and any suggested methods for minimizing |
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| respondent burden, including through the use of automated collection techniques to the Director, |
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| Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 |
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| Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any |
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| correspondence. Do not send the completed form to this address. |
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HIDDEN FIELDS |
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yes |
Lab Test |
4 |
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no |
Field Test |
2 |
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1 |
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Large SI |
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Small SI |
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Marine SI |
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Fail? |
Count |
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0 |
1 |
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0 |
1 |
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0 |
1 |
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0 |
1 |
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0 |
1 |
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0 |
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0 |
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0 |
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0 |
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0 |
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0 |
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0 |
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0 |
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0 |
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0 |
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