Information
Business Info
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Business Name
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Conducted on
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Prepared by
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Pepco Account Number
Contact Info
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Name
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Title
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Phone
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E-mail
Facility Info
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Name on Utility Bill
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Business Type (General)
- Agriculture
- Industrial
- Large Commercial
- Small Commercial
- Government
- Healthcare
- Education
- Non-Profit
- Other (Describe)
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Business Type (Specific)
- Farms
- Dairies
- Livestock farm
- Greenhouse
- Refrigerated Warehouse
- Food Processor
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Business Type (Specific)
- Fabrication
- Process
- Heavy manufacturing
- Warehouse
- Laboratories
- Biotech
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Business Type (Specific)
- Office building
- General retail
- Big box retail
- Large grocery store chain
- Warehouse
- Convenience Store
- Hospitality/Lodging
- Assusted Living
- Data Center
- Multifamily
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Business Type (Specific)
- Grocery Stores
- Convenience store
- Restaurants
- Food services
- Car dealerships
- Small Retail
- Small office
- Multifamily
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Business Type (Specific)
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Business Type (Specific)
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Business Type (Specific)
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Business Type (Specific)
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Business Type (Other)
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Address and Suite No.
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City
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Zip
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Age of building
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Facility Sqft.
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# of units if more than 1
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# Employees
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# Workstations
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Max Occupancy
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# Computers
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# Cash Registers
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Notes
Energy sources
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Electricity
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Natural Gas
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Heating Oil
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Propane
Gas Sources
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Gas Heat
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Gas Water Heat
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Gas Cooking
Business Hours
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Monday open time
- 12:00 AM
- 1:00 AM
- 2:00 AM
- 3:00 AM
- 4:00 AM
- 5:00 AM
- 6:00 AM
- 7:00 AM
- 8:00 AM
- 9:00 AM
- 10:00 AM
- 11:00 AM
- 12:00 PM
- 1:00 PM
- 2:00 PM
- 3:00 PM
- 4:00 PM
- 5:00 PM
- 6:00 PM
- 7:00 PM
- 8:00 PM
- 9:00 PM
- 10:00 PM
- 11:00 PM
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Monday close time
- 12:00 AM
- 1:00 AM
- 2:00 AM
- 3:00 AM
- 4:00 AM
- 5:00 AM
- 6:00 AM
- 7:00 AM
- 8:00 AM
- 9:00 AM
- 10:00 AM
- 11:00 AM
- 12:00 PM
- 1:00 PM
- 2:00 PM
- 3:00 PM
- 4:00 PM
- 5:00 PM
- 6:00 PM
- 7:00 PM
- 8:00 PM
- 9:00 PM
- 10:00 PM
- 11:00 PM
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Tuesday Same as above?
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Tuesday open time
- 12:00 AM
- 1:00 AM
- 2:00 AM
- 3:00 AM
- 4:00 AM
- 5:00 AM
- 6:00 AM
- 7:00 AM
- 8:00 AM
- 9:00 AM
- 10:00 AM
- 11:00 AM
- 12:00 PM
- 1:00 PM
- 2:00 PM
- 3:00 PM
- 4:00 PM
- 5:00 PM
- 6:00 PM
- 7:00 PM
- 8:00 PM
- 9:00 PM
- 10:00 PM
- 11:00 PM
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Tuesday close time
- 12:00 AM
- 1:00 AM
- 2:00 AM
- 3:00 AM
- 4:00 AM
- 5:00 AM
- 6:00 AM
- 7:00 AM
- 8:00 AM
- 9:00 AM
- 10:00 AM
- 11:00 AM
- 12:00 PM
- 1:00 PM
- 2:00 PM
- 3:00 PM
- 4:00 PM
- 5:00 PM
- 6:00 PM
- 7:00 PM
- 8:00 PM
- 9:00 PM
- 10:00 PM
- 11:00 PM
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Wednesday Same as above?
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Wednesday close time
- 12:00 AM
- 1:00 AM
- 2:00 AM
- 3:00 AM
- 4:00 AM
- 5:00 AM
- 6:00 AM
- 7:00 AM
- 8:00 AM
- 9:00 AM
- 10:00 AM
- 11:00 AM
- 12:00 PM
- 1:00 PM
- 2:00 PM
- 3:00 PM
- 4:00 PM
- 5:00 PM
- 6:00 PM
- 7:00 PM
- 8:00 PM
- 9:00 PM
- 10:00 PM
- 11:00 PM
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Wednesday close time
- 12:00 AM
- 1:00 AM
- 2:00 AM
- 3:00 AM
- 4:00 AM
- 5:00 AM
- 6:00 AM
- 7:00 AM
- 8:00 AM
- 9:00 AM
- 10:00 AM
- 11:00 AM
- 12:00 PM
- 1:00 PM
- 2:00 PM
- 3:00 PM
- 4:00 PM
- 5:00 PM
- 6:00 PM
- 7:00 PM
- 8:00 PM
- 9:00 PM
- 10:00 PM
- 11:00 PM
-
Thursday Same as above?
-
Thursday close time
- 12:00 AM
- 1:00 AM
- 2:00 AM
- 3:00 AM
- 4:00 AM
- 5:00 AM
- 6:00 AM
- 7:00 AM
- 8:00 AM
- 9:00 AM
- 10:00 AM
- 11:00 AM
- 12:00 PM
- 1:00 PM
- 2:00 PM
- 3:00 PM
- 4:00 PM
- 5:00 PM
- 6:00 PM
- 7:00 PM
- 8:00 PM
- 9:00 PM
- 10:00 PM
- 11:00 PM
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Thursday close time
- 12:00 AM
- 1:00 AM
- 2:00 AM
- 3:00 AM
- 4:00 AM
- 5:00 AM
- 6:00 AM
- 7:00 AM
- 8:00 AM
- 9:00 AM
- 10:00 AM
- 11:00 AM
- 12:00 PM
- 1:00 PM
- 2:00 PM
- 3:00 PM
- 4:00 PM
- 5:00 PM
- 6:00 PM
- 7:00 PM
- 8:00 PM
- 9:00 PM
- 10:00 PM
- 11:00 PM
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Friday Same as above?
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Friday close time
- 12:00 AM
- 1:00 AM
- 2:00 AM
- 3:00 AM
- 4:00 AM
- 5:00 AM
- 6:00 AM
- 7:00 AM
- 8:00 AM
- 9:00 AM
- 10:00 AM
- 11:00 AM
- 12:00 PM
- 1:00 PM
- 2:00 PM
- 3:00 PM
- 4:00 PM
- 5:00 PM
- 6:00 PM
- 7:00 PM
- 8:00 PM
- 9:00 PM
- 10:00 PM
- 11:00 PM
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Friday close time
- 12:00 AM
- 1:00 AM
- 2:00 AM
- 3:00 AM
- 4:00 AM
- 5:00 AM
- 6:00 AM
- 7:00 AM
- 8:00 AM
- 9:00 AM
- 10:00 AM
- 11:00 AM
- 12:00 PM
- 1:00 PM
- 2:00 PM
- 3:00 PM
- 4:00 PM
- 5:00 PM
- 6:00 PM
- 7:00 PM
- 8:00 PM
- 9:00 PM
- 10:00 PM
- 11:00 PM
-
Saturday Same as above?
-
Saturday close time
- 12:00 AM
- 1:00 AM
- 2:00 AM
- 3:00 AM
- 4:00 AM
- 5:00 AM
- 6:00 AM
- 7:00 AM
- 8:00 AM
- 9:00 AM
- 10:00 AM
- 11:00 AM
- 12:00 PM
- 1:00 PM
- 2:00 PM
- 3:00 PM
- 4:00 PM
- 5:00 PM
- 6:00 PM
- 7:00 PM
- 8:00 PM
- 9:00 PM
- 10:00 PM
- 11:00 PM
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Saturday close time
- 12:00 AM
- 1:00 AM
- 2:00 AM
- 3:00 AM
- 4:00 AM
- 5:00 AM
- 6:00 AM
- 7:00 AM
- 8:00 AM
- 9:00 AM
- 10:00 AM
- 11:00 AM
- 12:00 PM
- 1:00 PM
- 2:00 PM
- 3:00 PM
- 4:00 PM
- 5:00 PM
- 6:00 PM
- 7:00 PM
- 8:00 PM
- 9:00 PM
- 10:00 PM
- 11:00 PM
-
Sunday Same as above?
-
Sunday close time
- 12:00 AM
- 1:00 AM
- 2:00 AM
- 3:00 AM
- 4:00 AM
- 5:00 AM
- 6:00 AM
- 7:00 AM
- 8:00 AM
- 9:00 AM
- 10:00 AM
- 11:00 AM
- 12:00 PM
- 1:00 PM
- 2:00 PM
- 3:00 PM
- 4:00 PM
- 5:00 PM
- 6:00 PM
- 7:00 PM
- 8:00 PM
- 9:00 PM
- 10:00 PM
- 11:00 PM
-
Sunday close time
- 12:00 AM
- 1:00 AM
- 2:00 AM
- 3:00 AM
- 4:00 AM
- 5:00 AM
- 6:00 AM
- 7:00 AM
- 8:00 AM
- 9:00 AM
- 10:00 AM
- 11:00 AM
- 12:00 PM
- 1:00 PM
- 2:00 PM
- 3:00 PM
- 4:00 PM
- 5:00 PM
- 6:00 PM
- 7:00 PM
- 8:00 PM
- 9:00 PM
- 10:00 PM
- 11:00 PM
Lighting
Outdoor Lighting
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Outdoor Lighting
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Lamp Type
- Incandescent
- Halogen
- CFL
- T12
- T8
- T5
- Metal Halide
- Mercury Vapor
- LED
- U-Tube T12
- U-Tube T8
- Case LED
- Wall Pack
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Ballast Type
- Magnetic
- Electronic
- Rapid Start
- Instant Start
- Programmed Start
- Dimmable
- Tandem-Wired
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Base type
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# of lamps per ballast
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Base type
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Watts
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Ballast Type
- Magnetic
- Electronic
- Rapid Start
- Instant Start
- Programmed Start
- Dimmable
- Tandem-Wired
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Base type
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Size (ex. 2x4)
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Base type
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Watts
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Quantity
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Height from ground (ft.)
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Shape
- A-Lamp
- Par20
- Par30
- Par38
- R20
- R30
- R40
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Existing Controls
- Switches
- Timers
- Photocell
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Controls Working?
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Picture
Indoor Lighting
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Indoor Lighting
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Room Type
- Private office
- Conference room
- Corridor
- copier room
- break room
- general
- exterior
- storage room
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A/C?
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Lamp Type
- Incandescent
- Halogen
- CFL
- T12
- T8
- T5
- Metal Halide
- Mercury Vapor
- LED
- U-Tube T12
- U-Tube T8
- Case LED
- Wall Pack
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Base type
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# of lamps per ballast
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Watts
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Base type
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Watts
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Base type
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Base type
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Ballast Type
- Magnetic
- Electronic
- Rapid Start
- Instant Start
- Programmed Start
- Dimmable
- Tandem-Wired
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Size (ex. 2x4)
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Fixture Width
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Fixture Width
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Fixture Width
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Fixture Width
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Quantity
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Height from ground (ft.)
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Shape
- A-Lamp
- Par20
- Par30
- Par38
- R20
- R30
- R40
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Existing Controls
- Switches
- Occupancy Sensors
- Timers
- Daylighting
- Photocell
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Controls Working?
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Install Occ. Sensor?
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Picture
HVAC
HVAC
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HVAC
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Unit ID
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Location
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Room Served
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Type
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Size (tons)
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Make & Model
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Age
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Control Type (Thermostat, EMS) & Manufacturer
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Occupied set point
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Unoccupied set point
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Does it have an economizer?
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Programmable Thermostat?
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Recommendations
- Tune-Up
- Econ Test
- Econ Repair
- Dual-Enth
- AQ Op
- DCV
Water Heating
Water Heating
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Existing Water Heating
Water Heating
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Type
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Energy Star
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Quantity
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Size (gals)
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Pipes insulated?
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Tank wrapped?
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Age
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Condition/Comments
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Picture
Kitchen Equipment
Refrigeration Equipment
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Existing Refrigerator Equipment
Refrigerator
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Refrigerator Type
- Comm refrigerator, solid door
- Commercial freezer
- Refrigerated display, glass door
- Refrigerated display, no door
- Refrig. display, freezer, glass door
- Refrig. display, coffin type freezer
- Residential type refrigerator, small
- Residential type refrigerator, med
- Residential type refrig. w/ice dispenser
- Residential type chest freezer
- Residential type upright freezer
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Quantity
Walk Ins
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Existing Walk Ins
Walk Ins
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Walk In Type
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Quantity
Ice Makers
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Existing Ice Makers
Ice Makers
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Ice Maker Type
- Ice maker, self contained, small
- Ice maker, self contained, med
- Ice maker, self contained, large
- Ice maker, water cooled small
- Ice maker, water cooled med
- Ice maker, water cooled large
- Ice maker, remote Cond. Unit, small
- Ice maker, remote Cond. Unit, med
- Ice maker, remote Cond. Unit, large
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Quantity
Food Services
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Existing Food Service Equipment
Food Service Equipment
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Food Service Type
- Standard Fat Fryer
- Standard Steam Cookers
- Standard Hot Food Holding Cabinet (Full-size cabinet)
- Standard Hot Food Holding Cabinet (Three-Quarter size cabinet)
- Standard Hot Food Holding Cabinet (Half-size cabinet)
- Standard Griddles
- Standard Combination Ovens
- Standard Convection Ovens
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Quantity
Motors
Motors
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Existing Motors
- Air Compressor
- Air Conditioning Chiller Compressor
- Boiler Draft Fan
- Boiler Feedwater Pump
- Building Exhaust Fan
- Chilled Water (ChW) Pump
- Condensate Pump (for AC)
- Condensate Pump (steam system)
- Condenser Water Pump
- Cooling Tower Fan
- Domestic Water Booster Pump
- Domestic Water Circ Pump
- Hot Water Pump
- HVAC Exhaust Fan
- HVAC Return Air Fan
- HVAC Supply Air Fan
- Make-Up Air Fan
- Other
- Pool Pump
- Process Cooling Pump
- Process Exhaust Fan or Fume Hood
- Transfer Pump
- Wastewater Pump
- Well Pump
- WSHP Circ Loop Pump
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HP
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Quantity
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Room Served
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Age (yrs)
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VFD Annual kWh Reduction
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Condition/ Comments
Control Equipment
Control Equipment
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Existing Control Equipment
Control equipment
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Existing Control Equipment
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Quantity
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Location
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Comments
Vending Machines
Non-Refrigerated
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Quantity
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Controls
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Age (years)
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Conditions/Comments
Refrigerated
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Quantity
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Controls
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Age (years)
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Conditions/Comments
Custom
Custom measures
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Custom fixtures?
Fixture type
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Custom Measures
- Lighting & Controls
- Building Controls
- Chiller
- VFD
- HVAC
- Refrigeration
- Fluid Flow
- Thermal Insulation
- Wndows
- Process Improvement
- Compressed Air
- Water Heating
- Other
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Measure location
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Notes
Recommended Measures
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Replace T12 lamps and magnetic ballasts with T8 lamps and electronic ballasts.
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Replace T12/T8 lamps with higher efficiency T8 or T5 fixtures.
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Replace T12/T8 lamps with LED fixtures
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Replace incandescent and compact fluorescent lamps with LEDs.
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Install new lighting fixtures with T8 lamps and electronic ballasts.
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Replace HID light fixtures with new high bay fluorescent fixtures.
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Replace standard HID lights with Pulse Start HID lights.
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Install new energy efficient outdoor lighting.
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Install occupancy sensors in your restrooms, equipment rooms, and storage rooms.
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Install LED/LEC exit lights.
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Optimize the performance of existing HVAC systems.
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Replace HVAC units with new high efficiency HVAC units.
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Replace existing food service equipment with high efficiency food service equipment.
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Replace small, shaded-pole motors with ECM motors on refrigeration evaporator fans.
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Install VFDs on motors over 2HP
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Install evaporative fan controllers for walk-in coolers.
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Install automated refrigerator door closes.
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Install vending machine controllers
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Install anti-sweat heater controls for glass refrigerated display doors.
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Install new high efficiency or Energy Star water heaters
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Install hotel room occupancy controls
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Install office equipment controls
No Cost Low Cost Measures
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Check and adjust thermostat's programmable settings
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Activate energy-saving features of computers, monitors and copiers
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Install reminder signs to turn off lights in daylit areas
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Check outdoor light controls for proper operation and settings
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Use window blinds to allow natural light to fill an area instead of artificial lights
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Check and adjust water heater thermostat settings to 115F - 120F range if dish washing is not a factor
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Encourage the purchase of energy efficient equipment (Energy Star Qualified) as a standard practice
