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Cogeneration Screening Form

Company / Contact Information:

Example >>>

Company Name:
Facility Location	AL AZ AR CA CO CT DE DC FL GA ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Contact Name
Contact Phone	( ) - Ext. (If Applicable)
Contact Fax	( ) -
Contact Email

Energy Demand:
Summer Power (average kW):
Winter Power (average kW):
Fall/Spring (average kW):
Summer Steam (average lb/hr @ conditions):
Winter Steam (average lb/hr @ conditions):
Fall/Winter Steam (average lb/hr @ conditions):
Summer Chilled Water (tons/hr @ conditions):
Winter Chilled Water (tons/hr @ conditions):
Fall/Winter Chilled Water (tons/hr @ conditions):
Fuel type used (natural gas/liquid/other):

Existing Equipment Data:
Steam boiler efficiency (percent HHV):
Chilled water system driver (power/steam/absorption):
Upcoming capital expenses (expansion, replacement):
Abnormal operating expenses due to mechanical condition:

Current Energy Cost:
Average power cost (US$/kW):
Average natural gas fuel cost (US$/MMBtu):
Average liquid fuel cost (US$/MMBtu):
If multiple fuel used, percent of each:

Additional Comments / Information:

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