Form SVY010X Independent Surveyor Reporting for Fuels

OMB Control No. ####-####

Expires: ##/##/####

Instructions for SVY010#: Independent Surveyor Reporting for Fuels

Who must report

Any independent surveyor must report on test results for gasoline and diesel on a per-sample basis. A separate report must be submitted for each retail outlet surveyed during the averaging period.

Reporting requirements

• 40 CFR 1090 subpart J provides key requirements and reporting information (available at [link to ECFR.gov]).

Reporting deadlines

• Independent surveyors must submit quarterly reports by the following deadlines:

Calendar Quarter	Time Period Covered	Quarterly Report Deadline
Quarter 1	January 1-March 31	June 1.
Quarter 2	April 1-June 30	September 1.
Quarter 3	July 1-September 30	December 1.
Quarter 4	October 1-December 31	March 31.

How to submit reports

• EPA maintains report templates, electronic submission procedures and additional support options at https://www.epa.gov/fuels-registration-reporting-and-compliance-help/reporting-fuelprograms.

Field Instructions

Field No.	Field Name	Units	Field Formats, Codes & Special Instructions
1	Report Form ID		AAAAAA; Character. Enter SVY010#
2	Report Type		A; Character. Specify if the data submitted in this report is original or if it is being resubmitted. Submit only one original report; any corrections or updates should be marked as a resubmission. O = Original R = Resubmission
3	CBI		A; Character. Specify if the data contained within the report is claimed as Confidential Business Information (CBI) under 40 CFR Part 2, subpart B: Y = Confidential Business Information N = Non-Confidential Business Information
4	Report Date		MM/DD/YYYY; Character. Enter the date the original or resubmitted report is created.
5	Compliance Period		YYYY; Character. Enter the averaging/compliance year the report covers.
6	Compliance Period Quarter		AA; Character. Enter the quarter of the compliance period the report covers. Q1 – January 1 – March 31 Q2 – April 1 – June 30 Q3 – July 1 – September 30 Q4 – October 1 – December 31
7	Reporter ID		AAAA; Character. Enter the EPA-assigned four-character ID of the independent surveyor submitting the report.
8	Retail Outlet ID		AAAAA; Character. Enter the independent surveyor assigned identification number for the retail outlet
9	Retail Outlet Street Address		AAAAAAAAA; Character. Enter the street address of the retail outlet
10	Retail Outlet City		AAAAAAAAA; Character. Enter the city of the retail outlet
11	Retail Outlet – State		AA; Character. Enter the two-character state abbreviation of the retail outlet
12	Retail Outlet – Zip		AAAAA; Zip Code. Enter the zip code of the retail outlet
13	Retail Outlet – Brand Name		AAAAAAAAA; Character. Enter the displayed fuel manufacturer brand name at the retail outlet, if any
14	Fuel Dispenser Label		AAAAAA; Character. Enter the code representing the fuel dispenser label by selecting one of the codes below E0 – E0 gasoline E10 – E10 gasoline E15 – E15 gasoline E85 – E85 gasoline DSL – Diesel fuel UNK - Unknown OTH - Other
15	Sample Collection Date		MM/DD/YYYY; Character. Date the reported sample was collected.
16	Sample Collection time		9999; Character. Enter the time the sample was collected formatted using military time.
17	Sulfur	ppm	999; Number.
18	Sulfur Parameter Test Method		AAAAA; Character. Identify the ASTM Method number (e.g., D5191). If sample was un-tested, state “Untested”.
19	Oxygenate - Volume	volume %	99.99; Number. Diesel Samples Only – Enter “NA”
20	Oxygenate - Weight	Weight %	99.99; Number Diesel Samples Only – Enter “NA”
21	Oxygenate Parameter Test Method		AAAAA; Character. Identify the ASTM Method number (e.g., D5191). If sample was un-tested, state “Untested”.
22	Oxygenate Type		AAAAA; Character. Identify each type of oxygenate used by providing one of the codes below: ETOH – denatured fuel ethanol MTBE – methyl tertiary butyl ether (MTBE) ETBE – ethyl tertiary butyl ether (ETBE) ISOB - isobutanol TAME – tertiary amyl methyl ether (TAME) MTHL – methanol TBUT – tert-butanol UNKN – Unknown OTHR – Other If “Other”, enter the name of the oxygenate in the “Comments” field
23	Benzene	volume %	9.99; Number. Diesel Samples Only – Enter “NA”
24	Benzene Parameter Test Method		AAAAA; Character. Identify the ASTM Method number (e.g., D5191). If sample was un-tested, state “Untested”.
25	RVP	psi	99.99; Number. Enter result only for BOB. Diesel Samples Only – Enter “NA”
26	RVP Parameter Test Method		AAAAA; Character. Identify the ASTM Method number (e.g., D5191). If sample was un-tested, state “Untested”.
27	API Specific Gravity	API	99.99; Number. Diesel Samples Only – Enter “NA”
28	API Specific Gravity Parameter Test Method		AAAAA; Character. Identify the ASTM Method number (e.g., D5191). If sample was un-tested, state “Untested”.
29	Aromatics	Vol %	99.9; Number. Diesel Samples Only – Enter “NA”
30	Aromatics Parameter Test Method		AAAAA; Character. Identify the ASTM Method number (e.g., D5191). If sample was un-tested, state “Untested”.
31	Olefin	Vol %	99.9; Number. Diesel Samples Only – Enter “NA”
32	Olefin Parameter Test Method		AAAAA; Character. Identify the ASTM Method number (e.g., D5191). If sample was un-tested, state “Untested”.
33	E200	%	999.9; Number. Diesel Samples Only – Enter “NA”
34	E200 Parameter Test Method		AAAAA; Character. Identify the ASTM Method number (e.g., D5191). If sample was un-tested, state “Untested”.
35	E300	%	999.9; Number. Diesel Samples Only – Enter “NA”
36	E300 Parameter Test Method		AAAAA; Character. Identify the ASTM Method number (e.g., D5191). If sample was un-tested, state “Untested”.
37	T50	Degrees Fahrenheit	999.9; Number. Diesel Samples Only – Enter “NA”
38	T50 Parameter Test Method		AAAAA; Character. Identify the ASTM Method number (e.g., D5191). If sample was un-tested, state “Untested”.
39	T90	Degrees Fahrenheit	999.9; Number. Diesel Samples Only – Enter “NA”
40	T90 Parameter Test Method		AAAAA; Character. Identify the ASTM Method number (e.g., D5191). If sample was un-tested, state “Untested”.
41	Comments	N/A	AAAAA – Enter any additional information or recordkeeping specific to this sample as needed.

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