New Company Request CR-3358

OMB 2060-0277
OMB 2060-0308
OMB 2060-0637
07/15/2014 01:37 PM

New Company Request CR-3358
ICR Example Company

Request Information
Request ID :
Request Type :
Request Status :
Company Name :

CR-3358
New Company
Awaiting RCO Wet Ink Signature
ICR Example Company

Created On :
Modified On :
Requested By :
Username :

07/15/2014
07/15/2014
Jason Wilcox
JMWILCOX10

-

Page 1 of 9

OMB 2060-0277
OMB 2060-0308
OMB 2060-0637
07/15/2014 01:37 PM

New Company Request CR-3358
ICR Example Company

Company Info
Basic Information
Company Name and Location
Company ID :
Company Name : ICR Example Company
Created On (MM/DD/YYYY) : 07/15/2014
Valid From (Start Date 07/15/2014
MM/DD/YYYY) :
Valid To (End Date
MM/DD/YYYY) :

Address 1 : 123 Road
Address 2 :
City : Springfield
State : Illinois
Postal Code : 55555
Country : United States

Responsible Corporate Officer (RCO) Info
RCO CDX User ID :
RCO Name : John Smith
RCO Title : CEO
RCO E-mail : [email protected]
RCO Phone : 5555555555
RCO Fax :

Program Type and Business Activities
Program Type and Business Activities
Gasoline
Refiner
Diesel
Non-Renewable Fuels Importer
Renewable Fuel Standard
Renewable Fuel Producer

Company Foreign Bond
Gasoline : No
Renewable Fuel Standard : No

Refiner Compliance Level
Pursuant to 80.1406(c)(1), an obligated party may comply with its annual compliance requirements for all of its refineries in the
aggregate, or for each refinery individually. However, if the obligated party carries a deficit from one year to the next, then the party
must maintain the same approach to aggregation in the next calendar year. Please indicate the compliance level below:
Aggregation of Refineries

Company Contacts

There are currently no company contacts.

Page 2 of 9

OMB 2060-0277
OMB 2060-0308
OMB 2060-0637
07/15/2014 01:37 PM

New Company Request CR-3358
ICR Example Company

Facility List

ID

Name
ICR Sample Facility

Type
Gas/Ethanol

Location
123 Street
Springfield, Illinois 55555
United States

ICR Sample Importer

Diesel/Biodiesel

123 Drive
Springfield, Illinois 55555
United States

Legend:

Added

Updated

Removed

Unchanged

Page 3 of 9

OMB 2060-0277
OMB 2060-0308
OMB 2060-0637
07/15/2014 01:37 PM

New Company Request CR-3358
ICR Example Company

Facility: ICR Sample Facility
Facility Type & Activities

Facility Type
Gas/Ethanol
Description of Aggregated Distribution System

Facility Activities
Renewable Fuel Producer
Ethanol Producer
Refiner

Basic Information
Facility Name and Location
Facility Name : ICR Sample Facility
Valid From (Start Date 07/15/2014
MM/DD/YYYY) :
Valid To (End Date
MM/DD/YYYY) :

Address 1 : 123 Street
Address 2 :
City : Springfield
State : Illinois
Postal Code : 55555
Country : United States

Facility Contact
Contact Name : John Smith
Contact Title : CEO
Contact E-mail : [email protected]
ov
Contact Phone : 5555555555
Contact Fax :

Record Storage
Record Storage
Records for this facility are stored : On Site

Independent Lab
Independent Lab
Does this facility produce Reformulated Gasoline (RFG) and/or Reformulated Gasoline Blendstock for Oxygenate Blending (RBOB)?
Yes
Independent Analysis Option 2 (10%)
Requirement Options :
Approval Date of In-Line 07/15/2014
Blending Petition
(MM/DD/YYYY) :
Lab ID : 9999

City : Springfield
State : Illinois
Postal Code : 55555
Country : United States

Lab Name : Test Lab

Page 4 of 9

OMB 2060-0277
OMB 2060-0308
OMB 2060-0637
07/15/2014 01:37 PM

New Company Request CR-3358
ICR Example Company

Renewable Facility Information
Renewable Facility
Facility not subject to the Fuels and Fuel Additive Registration (FFARS Part 79) because fuel produced is for off road use only.
No
Facility not subject to the 20% GHG Threshold (Title 40 CFR 80.1403)
No

Fuels Imported/Created & Pathways
Facility Totals
Permitted Capacity (gallons) : 60000

:

Actual Peak Capacity (gallons) : N/A

:

Renewable Fuel & Pathway
Renewable Fuel Type: (D6) Renewable Fuel; Renewable Fuel: (10) Noncellulosic Ethanol; Processes: (10) Grandfathered (Dry Mill, Natural Gas Fired);
Feedstocks: (10) Starch -- Corn; Co-products: (20) Dry Distillers Grains, 10)
Wet Distillers Grains

FFARS ID

Permitted Capacity Actual Peak
(gallons)
Capacity (gallons)
123456789 60000
N/A

Page 5 of 9

OMB 2060-0277
OMB 2060-0308
OMB 2060-0637
07/15/2014 01:37 PM

New Company Request CR-3358
ICR Example Company

Facility: ICR Sample Importer
Facility Type & Activities

Facility Type
Diesel/Biodiesel
Diesel Facility Type : Aggregate Facility
Description of Aggregated Distribution System

Facility Activities
Non Renewable Fuels Importer Facility

Basic Information
Facility Name and Location
Facility Name : ICR Sample Importer
Valid From (Start Date 07/15/2014
MM/DD/YYYY) :
Valid To (End Date
MM/DD/YYYY) :

Address 1 : 123 Drive
Address 2 :
City : Springfield
State : Illinois
Postal Code : 55555
Country : United States

Facility Contact
Contact Name : John Smith
Contact Title : CEO
Contact E-mail : ICRsampleEmail@ICRsampleE
mail.gov
Contact Phone : 5555555555
Contact Fax :

Record Storage
Record Storage
Records for this facility are stored : On Site

Page 6 of 9

New Company Request CR-3358
ICR Example Company

OMB 2060-0277
OMB 2060-0308
OMB 2060-0637
07/15/2014 01:37 PM

I hereby attest that all the information on this document is correct:
Responsible Corporate John Smith
Officer Name:
Responsible Corporate ________________________________________
Officer Signature:

Date ______________

-

Page 7 of 9

New Company Request CR-3358
ICR Example Company

OMB 2060-0277
OMB 2060-0308
OMB 2060-0637
07/15/2014 01:37 PM

RCO Delegation Letter
To whom it may concern:
Please be advised that I John Smith, CEO, of ICR Example Company delegate Jason Wilcox, Test Title, to submit any and all
information to the United States Environmental Protection Agency in relation to EPA's Fuels Programs.
I authorize delegate Jason Wilcox to set up a Central Data Exchange (CDX) account and enable them to electronically sign and certify
reports submitted to the EPA, on my behalf. Jason Wilcox understands the reports and information they are submitting. Jason Wilcox is
my employee and is not a third party agent.
In addition, I acknowledge that I and the delegated person are responsible for the information submitted in accordance with the
regulations under title 40 CFR Part 80.
I also establish Jason Wilcox to register for and use the following CDX applications on my company's behalf. Please confirm the
delegate's program role selections by marking the appropriate program roles below with an X. Delegate Jason Wilcox has requested
access to the following program roles:
DC Fuels Submitter, Title 40 CFR Part 80 Subpart I, DC Fuels Submitter, Title 40 CFR Part 80 Subparts K and M, EMTS Submitter,
Company Editor
[ ] QAP Auditor – My delegate may edit any currently registered QAP information for ICR Example Company. Additionally, they may
create new QAP relationships to any registered fuel producing companies on my behalf.
OTAQReg: Fuels Programs Registration -- This application is used for registration under 40 CFR Part 80
[ X ] OTAQReg: Fuels Programs Registration -- Company Editor Role -- Fuels programs registration portal: My delegate may edit and
electronically send registrations for my company.
[ ] OTAQReg: Fuels Programs Registration -- Company Viewer Role -- Fuels programs registration portal: My delegate may view my
company registration information.
[ ] OTAQReg: Fuels Programs Registration -- Limited Company Viewer Role -- Fuels programs registration portal: My delegate may
view my company registration information.
OTAQDCFuel: OTAQ DCFuels Application -- This application is used for the certification and submission of required reports under 40
CFR Part 80
[ X ] OTAQDCFUEL: OTAQ DC FUEL Application -- Submitter Role -- The portal provides users the ability to electronically sign and
submit encrypted reports over a secure connection. I understand I am granting my delegate the ability to send my reports via the portal,
obtain an electronic signature and that they will have the submitter role in the OTAQReg application for my company. The delegate will
also have the ability to retrieve copies of the record that they submit. In addition, I acknowledge that I and the delegated person are
responsible for the information submitted in accordance with the applicable subparts:
[ ] Reports under 40 CFR Part 79 Subparts A, B, C, D, and F -- Registration of Fuels and Fuel Additives
[ ] Reports under 40 CFR Part 80 Subparts D, E, F, H, J, and L -- Reformulated Gasoline / Anti-Dumping / Gasoline Toxics / Gasoline
Sulfur /Gasoline Benzene
[ X ] Reports under 40 CFR Part 80 Subpart I -- Motor Vehicle, Nonroad, Locomotive, and Marine Diesel Fuel
[ X ] Reports under 40 CFR Part 80 Subparts K and M -- Renewable Fuel Standard
OTAQEMTS: EPA Moderated Transaction System -- This application is used for Renewable Identification Number (RIN) transactions
under the Renewable Fuel Standard (RFS2)

Page 8 of 9

New Company Request CR-3358
ICR Example Company

OMB 2060-0277
OMB 2060-0308
OMB 2060-0637
07/15/2014 01:37 PM

[ X ] OTAQEMTS: OTAQ EMTS Application -- Submitter Role -- EPA Moderated Transaction System (EMTS): EMTS is required for
companies to generate and transact Renewable Identification Numbers (RINs) for the Renewable Fuel Standard (RFS2). I understand I
am granting my delegate the ability to perform all actions (including trades) for my company in EMTS and be assigned the submitter
role in the OTAQReg application.
[ ] OTAQEMTS: OTAQ EMTS Application -- Company Viewer Role -- EPA Moderated Transaction System (EMTS): EMTS is required
for companies to generate and transact Renewable Identification Numbers (RINs) for the Renewable Fuel Standard (RFS2). I
understand I am granting my delegate the ability to view all actions for my company in EMTS and be assigned the company viewer role
in the OTAQReg application.
OTAQWaiverCredits: Cellulosic Biofuel Waiver Credits Pay.gov Application -- This application allows obligated parties to purchase
Cellulosic Biofuel Waiver Credits in the RFS2 program (per 40 CFR 80.1456)
[ ] OTAQWaiverCredits: Cellulosic Biofuel Waiver Credits Pay.gov Application -- Company Submitter Role -- Pay.gov portal:
OTAQWaiverCredits is used by obligated parties to purchase cellulosic biofuel waiver credits to be applied to an obligated party's
renewable volume obligation (RVO). In order to use this application, the user must know the amount of cellulosic biofuel waiver credits
that the party needs. Additionally, a party may not purchase more credits than their party needs; nor may a party transfer credits to
another party. This role is only applicable to refiners and importers of obligated volumes per the renewable fuel standard program. My
delegate may purchase Cellulosic Biofuel Waiver Credits for my company through the OTAQWaiverCredits application in CDX.
Signed,

John Smith, CEO
[email protected]
5555555555 (phone)

Date _________________________

-

Page 9 of 9