 	 	 	 	 	 

OMB Control No. 2060-0347

 

	 	STATEMENT OF ENERGY PERFORMANCE	 	 	 

 	 	 	 	 	 	 	 	 

 	 	Enter Name	 	 	 	 	 

 	 	 	 	 	 	 	 	 

 	 	For 12-month period ending:	Enter Month/Day/Year	 	 	 

 	 	 	 	 	 	 	 	 

 	 	 	 	 	 	 	 	 

 	 	 	 	 	 	 	 	 

 	Facility Address	 	Owner's Address	 	Corporate Energy Manager
Contact	 	 

 	Enter Name	 	Owner's Name	 	Contact Name	 	 	 

 	Street Address	 	Street Address	 	Email Address	 	 	 

 	Address 2	 	Address 2	 	Phone Number	 	 	 

 	New York, NY	 	City, State	 	 	 	 	 

 	10000	 	ZIP	 	 	 	 	 

 	 	 	 	 	 	 	 	 

 	Automobile Assembly Plant 

 

	 	 	 

 	 

 	 	 	 	 	 	 	 	 

 	 	 	 	 	 	 	 	 

 	NOTE:	 	 	 	 	 	 	 

 	1. Applications for certification of plant energy performance to the
US EPA must be made within 4 months of Period Ending date. Award of the
ENERGY STAR is not final until approved by the US EPA.	 

 	 	 	 	 	 	 	 	 

 	2. All energy performance scores and supporting data must first be
verified by the US EPA or a US EPA-designated EPI reviewer if supporting
data is considered to be proprietary before submitting applications for
the ENERGY STAR.	 

 	 	 	 	 	 	 	 	 

 	3. An energy performance score of 75 is the minimum required score to
be considered eligible for the ENERGY STAR.	 

 	 	 	 	 	 	 	 	 

 	4. Estimates of energy and CO2 emissions savings are provided to
illustrate the difference between the benchmarked plant's energy use and
estimated CO2 emissions as compared to "an average plant" that is
defined as having an energy performance score at the 50th percentile.

The fuel mix used to estimate emissions data for the average plant is
the same as for the benchmarked plant.  These estimates are provided to
assist plants with communicating their energy and environmental
achievements.	 

 	 	 	 	 	 	 	 	 

 	For US EPA Use Only:	 	 	 	 	 	 

 	 	 	 	 	 	 	 	 

 	 	 	 	 	 	 	 	 

 	 	 	 	 	 	 	 	 

 	 	 	 	 	 	 	 	 

 	 	 	 	 	 	 	 	 



The public reporting burden for this collection of information is
estimated to range up to 15 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 5900-89

