Form 3520-20I Reformulated Gasoline Program Toxics Emission Performanc

19001

OMB 2060-0277 expires 4/30/2004 (see instructions)

Reformulated Gasoline Program
Toxics Emissions Performance
Averaging Report

United States
Environmental Protection Agency
Washington DC 20460

1.0) Identifying Information
1.1) Report Type (shade one)

Original
Re-submission
1.2) Report Date (mm/dd/yy)

/

/

1.3) RY

1.4) Company ID

1.5) Facility ID

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2.0) Compliance Calculations
2.2) Applicable Toxics
Performance
Standard
(% reduction)

2.1) Total Volume of Averaged
Reformulated Gasoline or
RBOB (gals)

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0

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2.4) Actual Total Toxics Emissions
Performance
(% reduction - gals)

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2.3) Compliance Total Toxics
Emissions Performance
(% reduction-gals)

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9
0

EPA Form 3520-20I (Rev. 01-2004)

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2.5) Actual Total - Compliance Total
(% reduction - gals)

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0

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Page 1 of 3

19001

OMB 2060-0277 expires 4/30/2004 (see instructions)

Reformulated Gasoline Program
Toxics Emissions Performance
Averaging Report

United States
Environmental Protection Agency
Washington DC 20460

Identifying Information (from page 1)

Report Date

1.5) Facility ID

/

Company ID
RY

/

1
2
3
4
5
6
7
8
9
0

2.0) Compliance Calculations (continued)
2.6) Incremental Volume of
Averaged Reformulated
Gasoline or RBOB
(MSAT) (gals)

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,

2.7) Compliance
Baseline Toxics
Value (MSAT)
(% reduction)

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.

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9
0

1
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9
0

2.8) MSAT Compliance Total Toxics
Emissions Performance
(% reduction-gals)

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9
0

1
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Completed Forms are US Mail:
to be submitted to
one of the following
addresses.

2.9) Actual Total - MSAT Compliance Total
(% reduction - gals)

,

U.S. E.P.A.
Commercial
Attn: REFGAS (6406J)
Delivery:
1200 Pennsylvania Avenue NW
Washington, DC 20460

EPA Form 3520-20I (Rev. 01-2004)

,

,

U.S. E.P.A.
Attn: REFGAS; (202) 343-9038
1310 L Street, NW
Washington, DC 20005
Page 2 of 3

19001

OMB 2060-0277 expires 4/30/2004 (see instructions)

Reformulated Gasoline Program
Toxics Emissions Performance
Averaging Report

United States
Environmental Protection Agency
Washington DC 20460

Identifying Information (from page 1)

1.5) Facility ID

Report Date

/

1
2
3
4
5
6
7
8
9
0

/

Company ID
RY
3.0) MSAT Compliance Summary
3.1) Credit (+) or Deficit (-) Carried Forward
from Previous Year (% reduction-gals)

3.2) Current Year's MSAT Compliance Before
Applying Credits or Deficits (% reduction-gals)

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-

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,

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0

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3.3) Credit (+) or Deficit (-) to Carry Forward
into Next Year (% reduction-gals)

-

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,

,

,

1
2
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5
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9
0

Completed Forms are US Mail:
to be submitted to
one of the following
addresses.

U.S. E.P.A.
Commercial
Attn: REFGAS (6406J)
Delivery:
1200 Pennsylvania Avenue NW
Washington, DC 20460

EPA Form 3520-20I (Rev. 01-2004)

U.S. E.P.A.
Attn: REFGAS; (202) 343-9038
1310 L Street, NW
Washington, DC 20005
Page 3 of 3