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**[ENERGY STAR^®^]{.smallcaps} Product Information Form for Use by
[ENERGY STAR]{.smallcaps} Commercial Steam Cooker Partners (Companies
who have joined [ENERGY STAR]{.smallcaps} 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]{.smallcaps} and report its own products. Information from this
form will be added to the list of [ENERGY STAR]{.smallcaps} qualified
commercial steam cookers. Please copy this form and return one for each
qualifying product model to the address provided below.*

> **Product Contact Information**

**Company
Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (For
public requesting product information)**

> **(As listed in Partnership Agreement)**

####  Name: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> Tel:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Fax:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

E-mail: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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

+-------------+-------------+----------+------+-------+--------------+
| Brand Name/ | Model Name  | Product  | Nu   | Fuel  | Fuel Type    |
| M           | & Number    | Type\*   | mber | Type  |              |
| anufacturer |             |          | of   |       | Heavy Load   |
|             |             |          | Pans |       | (Potato)     |
|             |             |          |      |       | Cooking      |
|             |             |          |      |       | Energy       |
|             |             |          |      |       | Efficiency   |
|             |             |          |      |       | (%)          |
+-------------+-------------+----------+------+-------+--------------+
|             |             |          |      |       |              |
+-------------+-------------+----------+------+-------+--------------+

\* Choose from boiler-based, steam-generated, atmospheric
("connectionless")

  ------------------------- ------------------------ --------------------
  Idle Energy Rate                                   Date Shipped

  Gas (Btu/hr)              Electric (watts)         

                                                     
  ------------------------- ------------------------ --------------------

Tested By: (Name of Independent Testing Firm or Self-Tested)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date Tested:
\_\_\_\_\_\_\_\_\_\_\_\_\_

###### *Note: testing must be done in accordance with ASTM Standard F1484-99.*

###### 

###### 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 Steam Cookers. These requirements
include:

[ڤ]{dir="rtl"} On the product [ڤ]{dir="rtl"} In product literature
[ڤ]{dir="rtl"} On Internet site

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

**E-mail** testing results/QPI forms to Rachel Schmeltz at
<schmeltz.rachel@epa.gov>

**Fax** results/QPI forms to Rachel Schmeltz at (202) 565-2077

**US Mail/Overnight/Express** results/QPI forms to: Rachel Schmeltz,
U.S. EPA, 501 3^rd^ Street NW, 5^th^ Floor, Washington, DC 20001