Form 3520-20d Reformulated Gasoline and Anti-Dumping Quarterly Certifi

10295

OMB 2060-0277 expires 7/31/2000 (see instructions)

United States
Environmental Protection Agency
Washington DC 20460

Reformulated Gasoline and Anti-Dum p ing
Quarterly Certification

1.0) Identification Information:
1.1) Company Name:

1.2) Facility Name:

2.0) Batch Reports
1.3) Reporting Party 1.4) Company ID#:

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2.2) Ending
Batch ID#

2.1) Starting
Batch ID#

1.6) Reporting
1.5) Facility ID#: Period (YYQ):

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2.3) Number of
Batch Reports

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3.0) Annual Report Information

Annual Reports (shade all that are included in this submission)
a) Annual Compliance Designation
b) RVP Averaging Report
c) VOC Emissions Performance Averaging Report

Mail to: U.S. E.P.A.
Attn: REFGAS (6406J)
1200 Pennsylvania Ave, NW
Washington, DC 20460

d) NOx Emissions Performance Averaging Report
e) Toxics Emissions Performance Averaging Report
f) Benzene Content Averaging Report
g) Oxygen Content Averaging Report

Commercial Delivery:
U.S. E.P.A.
Attn: REFGAS; 202-343-9038
1310 L Street, NW
Washington, DC 20005

h) Sulfur, T90 and Olefins Content Averaging Report
i) Credit Transfer Summary Reports(s)
j) Averaging Areas Report
k) Anti-Dumping Program Annual Report

EPA Form 3520-20D (Rev.10-95)

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10295

OMB 2060-0277 expires 7/31/2000 (see instructions)

United States
Environmental Protection Agency
Washington DC 20460

R e f o r m ulated Gasoline and Anti-Dum p ing
Quarterly Certification

Identification Information (from section 1.0 on page 1)
Reporting Party

Company

Facility

Reporting Period (YYQ)

4.0) Confidential Business Information Claim (shade one)
A company may assert a business confidentiality claim covering the information contained in this submission. If no such claim is made the information may be
made available to the public by EPA without further notice. All questions of confidentiality will be handled pusuant to 40 CFR Part 2. Is confidentiality claimed for
the information in this submission?

Yes

No

5.0) Certification
I certify that , to the best of my knowledge, the information included in this submission is complete and accurate.
5.1) Name of Responsible Corporate Officer:

5.2) Title:

5.4) Date:
/

5.3) Signature:

EPA Form 3520-20D (Rev.10-95)

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