PEER Application: Agricultural Compression-Ignited Internal Combustion Engines NOTE: Please complete one form for each engine subject to PEER. Accompany this form or set of with one completed General PEER Application form. PEER TO BE ISSUED TO (FACILITY NAME): LOCATION WHERE THE ENGINE WILL BE OPERATED: WELL # OR OTHER EQUIPMENT # (IF APPLICABLE): HAVE YOU APPLIED FOR FUNDING THROUGH THE DISTRICT FOR THIS REPLACEMENT ENGINE? YES NO IF YES, PLEASE COMPLETE THE FOLLOWING FIELDS POSSIBLE: DISTRICT FUNDING PROJECT NUMBER: SERIAL NUMBER OF NEW ENGINE: SERIAL NUMBER OF REPLACED ENGINE (IF IF YOU HAVE PROVIDED THE DISTRICT FUNDING PROJECT NUMBER AND SERIAL NUMBER(S), THIS FORM IS COMPLETE AND MAY BE SUBMITTED. ENGINE INFORMATION ENGINE MANUFACTURER: ENGINE MODEL YEAR: DATE OF INSTALLATION: ENGINE MAKE: ENGINE MODEL: ENGINE SERIAL #: ENGINE FAMILY: ENGINE CERTIFICATION LEVEL: (PLEASE PROVIDE DOCUMENTATION OF CERTIFICATION.) DETAILS TIER 1 TIER 2 TIER 3 INTERIM TIER 4 TIER 4 ENGINE’S MAX (INTERMITTENT) RATING: BHP ENGINE ENGINE’S CONTINUOUS POWER RATING: BHP ENGINE OPERATING SCHEDULE: PER YEAR MAXIMUM FUEL TYPE: DIESEL (PLEASE SPECIFY): ENGINE USE: WELL PUMP BOOSTER PUMP ELECTRICAL GENERATOR OTHER (PLEASE SPECIFY): IS THE ENGINE: STATIONARY TRANSPORTABLE DATA (IS MOVED TO OPERATE AT ANOTHER LOCATION OR AT “FOOTPRINT” PROCESS LEAST ONCE PER EACH OPERATING SEASON) Continued on Reverse – – DOES THE ENGINE HAVE A DISTRICT PORTABLE YES NO REGISTRATION? IF YES, PROVIDE REGISTRATION NUMBER:
PEER Application: Agricultural Compression-Ignited Internal Combustion Engines NOTE: Please complete one form for each engine subject to PEER. Accompany this form or set of with one completed General PEER Application form. PEER TO BE ISSUED TO (FACILITY NAME): LOCATION WHERE THE ENGINE WILL BE OPERATED: WELL # OR OTHER EQUIPMENT # (IF APPLICABLE): HAVE YOU APPLIED FOR FUNDING THROUGH THE DISTRICT FOR THIS REPLACEMENT ENGINE? YES NO IF YES, PLEASE COMPLETE THE FOLLOWING FIELDS POSSIBLE: DISTRICT FUNDING PROJECT NUMBER: SERIAL NUMBER OF NEW ENGINE: SERIAL NUMBER OF REPLACED ENGINE (IF IF YOU HAVE PROVIDED THE DISTRICT FUNDING PROJECT NUMBER AND SERIAL NUMBER(S), THIS FORM IS COMPLETE AND MAY BE SUBMITTED. ENGINE INFORMATION ENGINE DETAILS ENGINE MANUFACTURER: ENGINE MODEL YEAR: DATE OF INSTALLATION: ENGINE MAKE: ENGINE MODEL: ENGINE SERIAL #: ENGINE FAMILY: ENGINE CERTIFICATION LEVEL: (PLEASE PROVIDE DOCUMENTATION OF CERTIFICATION.) TIER 1 TIER 2 TIER 3 INTERIM TIER 4 TIER 4 ENGINE’S MAX (INTERMITTENT) RATING: BHP ENGINE’S CONTINUOUS POWER RATING: BHP MAXIMUM ENGINE OPERATING SCHEDULE: PER YEAR FUEL TYPE: DIESEL (PLEASE SPECIFY): PROCESS DATA ENGINE USE: WELL PUMP BOOSTER PUMP ELECTRICAL GENERATOR OTHER (PLEASE SPECIFY): IS THE ENGINE: STATIONARY TRANSPORTABLE (IS MOVED TO OPERATE AT ANOTHER LOCATION OR “FOOTPRINT” AT LEAST ONCE PER EACH OPERATING SEASON) – Continued on Reverse – DOES THE ENGINE HAVE A DISTRICT PORTABLE REGISTRATION? YES NO IF YES, PROVIDE REGISTRATION NUMBER:
PEER-Application-R4702-Ag-Compression-ICE.docx