3520-13B Supplemental Additive Manufacturer Annual Report

EPA Form 3520-13B (08-2003) - Supplemental Additive Manufacturer Annual Report

Page 1 of 1
Form Approval
OMB No. 2060-0150
Approval Expires 01/31/2004

U.S. Environmental Protection Agency
Office of Transportation and Air Quality

Leave Blank

Supplemental Additive Manufacturer Annual Report
1a. Company ID:

6. Production Values:
a. Additive ID:

2. Report Year:

b. Market:
A – Aftermarket
B – Bulk
C – Don't Know

Mail the completed form to:
U.S. Environmental Protection Agency
Attn: Fuel Additive Registration/Suite L-103
Mail Code - 6406J
1200 Pennsylvania Avenue, NW
Washington, DC 20460-0001
Telephone (202) 564-9754
Fax (202) 565-2153
email: [email protected], [email protected]
This office is operated by a contractor for the EPA.

3. Report Type: (Check Only One)
c Original
d
e
f
g

c. Production Volume:

g Resubmission
c
d
e
f

d. Production Units:
gal – Gallons
lb – Pounds
kg – Kilograms

or, via courier:
U.S. Environmental Protection Agency
Attn: Fuel Additive Registration/Suite L-103
Mail Code - 6406J
501 Third Street, NW
Washington, DC 20001