Customer Information

2018 PROCESS STEAM TRAP AUDIT PROGRAM REBATE APPLICATION FOR NATURAL GAS STEAM SYSTEM AUDITS AND REPAIR/PLACEMENT

Steam systems powered primarily by CenterPoint Energy natural gas or steam created using CenterPoint Energy natural gas are eligible for steam trap rebates. See log sheet for additional details. To receive your rebate:

Step 1 Perform the trap audit and note all failed traps on the Process Steam Trap Audit log. Step 2 Repair/replace all failed traps according to audit log process.

Step 3 Submit this sheet, the failed trap log, the trap audit invoice, and repair/replacement invoices (material and labor) to CenterPoint Energy to apply for rebates.

Company name

Natural-gas account number from CenterPoint Energy bill

Facility address

Mailing address

Contact person Phone

Email*The undersigned does hereby certify that 1: The undersigned, and not CenterPoint Energy, is solely responsible for the accuracy of the information contained in this application, and 2. All rules of this CenterPoint Energy program have been followed, and 3. The undersigned acknowledges that nothing contained in this application shall impose any liability on CenterPoint Energy for the work performance for this CenterPoint Energy program by the vendor.

Customer signature & dateNote: This document printed, then signed.

CenterPoint Energy account manager name

Alternate rebate recipient Optional - only complete this section if you want the rebate check sent to someone else.

Company name Attention

Mailing address

The undersigned does hereby authorize the preceding to receive the rebate check for this project.

Customer signature & dateNote: This document printed, then signed.

Contractor Information

Company Contact

Email* Phone

Mailing address

Contractor ID

*By providing your email address, you are granting CenterPoint Energy permission to send emails regarding this and other programs/services. Complete this form along with the Commercial System log tab, save a copy for your files, and send to your CenterPoint Energy account manger, or email it to:

If you need assistance or more information, please contact your CenterPoint Energy account manager, call (612) 321-4330 or (800-234-5800, ext 4330) or email the address above.

CNP 1310 (1-2018)

CENTERPOINT ENERGY BUSINESS USE ONLYTechnical Pre-Approval Date DateRegulatory ApprovalG/L acct 562020 Rebate AmountInternal order 11036682 Requesting Co. 0072RETURN CHECK TO COMMERCIAL REBATE PROCESSING, NICOLLET MALL

PROCESS STEAM TRAP AUDIT LOG STEAM TRAP AUDIT LOG FOR PROCESS/INDUSTRIAL CUSTOMERS

Use this log to document FAILED traps identified during a steam trap audit for process boilers. Complete and submit this log (electronic format preferred) along with the Rebate Application tab, audit invoice and steam-trap repair/replacement (material and labor) invoices to apply for your steam trap audit and potential steam trap repair/replacement rebate. Rebate details: Trap Audits are eligible for a $15/trap tested rebate provided all failed traps are replaced or repaired prior to submitting this application. Maximum audit rebate is 100% of invoiced cost. If labor was internal instead of contracted, please submit a labor log and loaded labor rate in lieu of the labor invoice. Trap repair/replacement also have the potential to earn a custom rebate up to $3.50/Dth of energy saved, with an estimated payback between 1 to 6 years. Our engineers will analyze the information below to determine what, if any, rebate is available. Orifice traps are not eligible for audit or repair/replacement rebates, and plugged trap repair should not be counted as a "failed" trap.

Location:Customer:

Estimated boiler efficiency:

Date audit completed Trap audit rebate# failed# of traps tested

TEST DATE TAG NUMBER MAKE

APPLICATION: SPACE HEATING (SH)

OR PROCESS (P)

1

8

7

6

5

4

3

2

MAX. OPERATING PRESSURE

(psig)

STEAM PRESSURE

(psig)

TRAP REPLACEMENT

COST

LABOR REPAIR/

REPLACEMET COST

PIPE SIZE

ORIFICE SIZE*

CNP 1310 (1-2018)

ANNUAL OPERATING HOURS

(FOR PROCESS TRAPS ONLY)

MODEL

*If unknown, fill out "pipe size" and max operating pressure" columns.

TEST DATE TAG NUMBER MAKE MODEL

APPLICATION: SPACE HEATING (SH)

OR PROCESS (P)

ORIFICE SIZE*

PIPE SIZE

MAX. OPERATING PRESSURE

(psig)

STEAM PRESSURE

(psig)

TRAP REPLACEMENT

COST

LABOR REPAIR/

REPLACEMENT COST

9

16

15

14

13

12

11

10

23

22

21

26

25

24

20

19

18

17

CNP 1310 (1-2018)

ANNUAL OPERATING HOURS

(FOR PROCESS TRAPS ONLY)

*If unknown, fill out "pipe size" and max operating pressure" columns.

TEST DATE TAG NUMBER MAKE MODEL

APPLICATION: SPACE HEATING (SH)

OR PROCESS (P)

27

34

33

32

31

30

29

28

41

40

39

44

43

42

38

37

36

35

PIPE SIZE

MAX. OPERATING PRESSURE

(psig)

STEAM PRESSURE

(psig)

TRAP REPLACEMENT

COST

LABOR REPAIR/

REPLACEMENT COST

ORIFICE SIZE*

CNP 1310 (1-2018)

ANNUAL OPERATING HOURS

(FOR PROCESS TRAPS ONLY)

*If unknown, fill out "pipe size" and max operating pressure" columns.