Ms. Rebecca Hindin

National Program Manager

ENERGY STAR 

U.S. Environmental Protection Agency

1310 L Street, NW (Room 913L)

Washington, DC  20005

Dear Ms. Hindin:

	As the corporate energy director for [name of company], I am writing to
nominate the following plant for award of the (Date) ENERGY STAR:

[Plant name]

[Plant street address]

[Plant city, state, zip code]

	As documented by the attached Statement of Energy Performance, I affirm
that the aforementioned plant meets the conditions necessary to qualify
for the ENERGY STAR, including:

Energy performance in the top 25 percent of similar existing plants,
indicated by a minimum rating of 75 out of 100 as determined through the
most current version of the ENERGY STAR plant energy performance
indicator tool for this type of plant; and,

Safe lighting levels that meet the Illuminating Engineering Society of
North America (IESNA) recommended best practices for industrial
facilities as described in IESNA Lighting Handbook; 9th Edition, Chapter
19.

	An objective assessment of the facility’s environmental record has
been conducted as described in U.S. Environmental Protection Agency’s
(EPA) Instructions for Applying for the ENERGY STAR.

	I have personally examined and am familiar with the information
contained in this Application.  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 plant would not meet all EPA
program requirements for receiving the ENERGY STAR.

	I am submitting this application within 4 months of the Period Ending
Date on the enclosed Statement of Energy Performance.  I understand EPA
reserves the right to request and review any records which support the
data used to produce the energy performance rating for this plant.  I
also certify that I am maintaining a file on this plant in accordance
with EPA’s file maintenance guidelines.  Furthermore, I agree to
associate the ENERGY STAR name and logo only with the aforementioned
plant and to adhere to ENERGY STAR’s Identity Guidelines.

Sincerely,

Signature__________________________

Signatory Name (Corporate Energy Manager for [Company
name]):_________________

Facility Owner:_________________________

Attachments: Statement of Energy Performance, EPI Printout, Award
Specification Sheet, Compliance Check Worksheet

The public reporting burden for this collection of information is
estimated to range up to 10 minutes 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.

EPA Form 5900-264

OMB Control No. 2060-0347

