9

8
7
6
5
4
3
2
1

30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
Item #

updated 7-28-06
Field Survey Form

Process Identification (list

individual system components)

type of fuel

pipe or tube material

(steel, copper etc.)

insulation type ASTM#

or name
NIA Mechanical Insulation Appraisal

jacket material &

description
NAIMA 3E Plus Program

vertical or horizontal

source efficiency
percent

hours of operation
per year
Location:
Date:

fuel heat cont. in Btu

cost of fuel to source

caution check units
$/kwh $/Mft3, $/gal, $/ton

process Temp F

avg. ambient temp F

rel hum - cold

pers protect temp - hot

wind speed MPH

pipe/tube size

inventoried insulation
thickness inches
Page 1 of 4

quantity SF or LF
9
8
7
6
5
4
3
2
1

30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10

Item #
 NIA Mechanical Insulation Appraisal Date: 0 Page 2 of 4
Energy Cost Report NAIMA 3E Plus Program Location: 0

Bare Surface Inventoried Surface Upgraded Insulation Surface

upgraded insulation thickness= inches
Item #

Item #
3E+ Energy 3E+ Energy 3E+ Energy Energy Savings = Cost Savings =
Cost 3E+ Heat Loss Energy Loss Cost 3E+ Heat Loss Energy Loss Cost 3E+ Heat Loss bare minus bare minus
$ / ft / yr Btu / ft / Btu Energy Cost $ / ft / yr Btu / ft / Btu Energy Cost $ / ft / yr Btu / ft / upgraded upgraded
yr / yr $ / yr yr / yr $ / yr yr Btu / yr $ / yr
1 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 1
2 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 2
3 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 3
4 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 4
5 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 5
6 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 6
7 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 7
8 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 8
9 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 9
10 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 10
11 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 11
12 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 12
13 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 13
14 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 14
15 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 15
16 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 16
17 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 17
18 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 18
19 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 19
20 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 20
21 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 21
22 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 22
23 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 23
24 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 24
25 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 25
26 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 26
27 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 27
28 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 28
29 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 29
30 0.00E+00 0 0.00E+00 0.00 0.00E+00 0 30
0.00E+00 $0 0.00E+00 $0 0.00E+00 $0
 NIA Mechanical Insulation Appraisal Date: 0.0 Page 3 of 4
Environmental Report NAIMA 3E Plus Program Location: 0.0

Emissions Assuming All Emissions From Inventoried

Emissions Assuming Bare Current Savings (emissions from bare Potential Savings (emissions from bare
Surfaces Insulated With surfaces minus emissions from inventoried surfaces minus emissions from surfaces
Surfaces Are Bare (current) Surfaces
0 inches of Insulation surfaces) surfaces with 0 of insulation)
Item #

Item #
CO2 NOX CE CO2 NOX CE CO2 NOX CE CO2 NOX CE CO2 NOX CE

LBs / ft/ yr LBs / ft/ yr LBs / ft/ yr LBs / ft/ yr LBs / ft/ yr LBs / ft/ yr LBs / ft/ yr LBs / ft/ yr LBs / ft/ yr LBs / yr LBs / yr LBs / yr LBs / yr LBs / yr LBs / yr

1 0 0 0 0 0 0 1
2 0 0 0 0 0 0 2
3 0 0 0 0 0 0 3
4 0 0 0 0 0 0 4
5 0 0 0 0 0 0 5
6 0 0 0 0 0 0 6
7 0 0 0 0 0 0 7
8 0 0 0 0 0 0 8
9 0 0 0 0 0 0 9
10 0 0 0 0 0 0 10
11 0 0 0 0 0 0 11
12 0 0 0 0 0 0 12
13 0 0 0 0 0 0 13
14 0 0 0 0 0 0 14
15 0 0 0 0 0 0 15
16 0 0 0 0 0 0 16
17 0 0 0 0 0 0 17
18 0 0 0 0 0 0 18
19 0 0 0 0 0 0 19
20 0 0 0 0 0 0 20
21 0 0 0 0 0 0 21
22 0 0 0 0 0 0 22
23 0 0 0 0 0 0 23
24 0 0 0 0 0 0 24
25 0 0 0 0 0 0 25
26 0 0 0 0 0 0 26
27 0 0 0 0 0 0 27
28 0 0 0 0 0 0 28
29 0 0 0 0 0 0 29
30 0 0 0 0 0 0 30
Totals 0 0 0 0 0 0
 NIA Mechanical Insulation Appraisal Page 4 of 4
Summary Report NAIMA 3E Plus Program

Date: 0.00
Location: 0.00

The following data was calculated using the NAIMA 3E Plus (version 4.0) computer program.

The existing insulation on the system saves approximately 0.00E+00 Btus of energy and $0 annually.

If the insulation on the system was increased to 0.0 inches the system would save approximately 0.00E+00 Btus of energy and $0 annually.
(note: this would be the total savings attributable to the insulation -this is not additional savings from upgrading the insulation)

Energy in BTUs Dollars

Cost to operate bare surfaces per year = 0.00E+00 $0

Cost to operate system with surfaces as currently insulated = 0.00E+00 $0

Cost to operate system with surfaces as insulated with 0 in. total = 0.00E+00 $0 Pounds
CO2 NOX CE
Savings with the use of current (inventoried) insulation versus no insulation = 0.00E+00 $0 0 0 0

Total potential savings assuming 0 in. insulation versus no insulation = 0.00E+00 $0 0 0 0

Additional potential savings assuming 0 in. insulation vs.current insulation = 0.00E+00 $0 0 0 0