Attachment
100 Low Carbon Emission Model Store
Recommendation Form
- Basic Information
Company Name
Contact Person / Telephone
Fax / Email
Recommended Store / Location (City)
Business Format / □Department Store □Hypermarket □Specialty Store (Home appliance, home product or others)
□ShoppingCenter □Supermarket □Convenience Store
Property Ownership / □Leased □Self-Owned
Store Conditions / □Over-one-year-oldstore with energy saving features
□Old store remodeled
Store Remodeling Work / Complete Time (MM/YYYY)
Average Energy Saving Rate %
- Energy Consumption of Recommended Store
Business Area (area that brings sales revenue) / m2 in2010 m2 in 2011
Self-owned area: m2 in 2010; m2 in 2011
Leased area: m2 in 2010; m2 in 2011
Sales Revenue with Tax (including rent but excluding revenue from leased area) / Yuan in 2010; Yuan in 2011
Total Energy Spending① / _Yuan in 2010; Yuan in 2011
Power Consumption / _KWH in 2010; KWH in 2011
Water Consumption / Fresh Water: m3 in 2010
m3 in 2011
Recycled Water: m3 in 2010
m3 in 2011
Oil Consumption / 2010 Crude Oil m3 Fuel Oil m3
Gasoline m3 Kerosene m3 Diesel m3
2011 Crude Oil m3 Fuel Oil m3
Gasoline m3 Kerosene m3 Diesel m3
Gas Consumption / 2010 Natural Gas m3
Liquefied Petroleum Gas m3
2011 Natural Gas m3
Liquefied Petroleum Gas m3
Heating in Winter / □Central Air Conditioning
□Government Heating Service □No Heating
□Other
Payment Method of Air Conditioning Cost / □Part of Power Consumption
□Part of Rent
Spending on Government Heating Service in Winter/Total Energy Spending Ratio / 2009 %
2010 %
2011 % (estimate)
Refrigerant Type / Air Conditioner Refrigerator
Application of Energy-Saving Lighting Facilities / □Billboard □In-Store Shop □Fresh Food Section □ShoppingArea
□Warehouse □Parking Lot □Others
Annual Sales Volume of Plastic Bags / units in 2009 units in 2010
①Total Energy Spending refers to total spending on water, power, gas, oil and public heating.
- Energy Saving and Environmental Protection Management Measures taken by Recommended Stores
1.□Set annual targets of energy saving and emission reduction: % in 2009, % in 2010, % in 2011
2.□Set up special department or appoint special workers responsible for energy saving and environmental protection. Please write down the name of the department:
3.□Annual staff training classes on knowledge concerning energy saving and environmental protection and other related job training times per year
4.□Encourage staff to meet energy-saving and emission reduction targets through various measures, such as making energy saving as one of their job responsibilities, rewarding employees that finish energy saving work and rewarding employees that put forward feasible programs or suggestions for saving energy.
Please write down concrete measures:
5.□Continuous recording of energy consumption data on major items, such as water and power, and take measures on abnormalities according to analysis of monitoring data.
6.□Monitoring and alarming system for refrigerant leak
7.□Energy-saving management plan for equipment operation, such as power peak load shifting plan
8.□Accredited by related state environment management system, such as ISO14001.
Please write down the name of the accreditation:
9.□Awarded or financially subsidized by government for energy-saving and environmental protection efforts / Source of financial subsidy:
Financial subsidy used to:
Note: Please provide written material or evidence for No. 4-8.
- Other Environmental Protection Measures of Recommended Stores
□Soot and sewage system and treatment measures
□Regular promotional events on saving energy and environmental protection for consumers, such as promotion week for energy-saving products
□Renewable energy use for building store infrastructure:
1.Geothermal energy 2.Wind power 3.Bio-energy 4.Solar energy
5.Photovoltaic power 6. Others:
□Environmentally friendly and energy-saving product offerings:
1. Food 2. Home appliances and electronics 3. Home products and building materials
4. Clothing 5. Stationary 6. General merchandise
- Summary on Energy Saving and Environmental Protection Works
1．Summary of energy-saving remodeling work in all stores
2． Energy-saving and environmental protection measures (at least five pieces) taken by recommended stores and their achievements
3．Application of fiscal support for the technological improvement of energy-saving features to state, provincial and municipal governments
Materials: (1) related project list; (2) application material
4．Monitoring and implementation of energy saving efforts
Test results of main energy-consuming equipment; construction and operation of online monitoring system for energy saving work
Materials: (1) test record of main energy-consuming equipment; (2) introduction of online monitoring system with its pictures
5．Training for energy saving work
5.1 Participation in government or social energy-saving training classes
Materials: (1) related training lists; (2) training description and class attendance
5.2 Energy saving training classes organized by companies
Materials: (1) related training lists; (2) training description and class attendance
6．Energy-saving promotion
6.1 Participation in government or social promotional events on saving energy
Participation in or cooperation with government or social organization in exchanging information on saving energy, experience on energy-saving management, consultation on energy management and extension work on energy-saving technologies and products
Materials: (1) acknowledge of receipt for signing up for an event or meeting; (2) meeting summary or picture
Note:
Application for and review of “100 Low Carbon Emission Stores”: According to their actual conditions, member companies and related companies can recommend 3 stores, which have their energy saving features debugged and have ripe operation models. Cross-region chain retailers can choose 3 representative stores respectively in 3 regions—northern-northeastern, eastern-southern and central China. CCFA will check and review companies’ application forms, including their store data and other relative information, and will establish an expert panel for further review.
Deadline for submitting Recommendation Form: Please fill in the “100 Low Carbon Emission Model Store” Recommendation Form (see Appendix 2) and send it to CCFA prior to January 5, 2011 by fax or email.
Contact: Zhang Jing
Telephone: 010-68784932
Email: