Appendix C to Subpart T of Part 431 - Certification Report for Distribution Transformers

All information reported in this Certification Report(s) is true, accurate, and complete. The company is aware of the penalties associated with violations of the Act, the regulations thereunder, and is also aware of the provisions contained in 18 U.S.C. 1001, which prohibits knowingly making false statements to the Federal Government.

Name of Company Official or Third-Party Representative: Signature of Company Official or Third-Party Representative: Title: Date: Equipment Type: Manufacturer: Private Labeler (if applicable): Name of Person to Contact for Further Information: Address: Telephone Number: Facsimile Number:

For Existing, New, or Modified Models: 1

Prepare tables that will list distribution transformer efficiencies. Each table should have a heading that provides the name of the manufacturer, as well as the type of transformer (i.e., low-voltage dry-type, liquid-immersed, or medium-voltage dry-type) and the number of phases for the transformers reported in that table. Each table should also have five columns, labeled “kVA rating,” “BIL rating” for medium-voltage units, “Least efficient basic model (model number(s)),” “Efficiency (%)” and “Test Method Used.” Each table should have one row for each of the kVA groups that are produced by the manufacturer and that are subject to minimum efficiency standards. In the “Test Method Used” column, the manufacturer should report whether the efficiency of the reported least efficient basic model in that kVA grouping was determined by testing or through the application of an alternative efficiency determination method.

Submit by Certified Mail to: U.S. Department of Energy, Office of Energy Efficiency and Renewable Energy, Building Technologies Program, Mailstop EE-2J), Forrestal Building, 1000 Independence Avenue, SW., Washington, DC 20585-0121.

Submit by E-mail to: [e-mail].