3520-20H Anti-Dumping Program Annual Report

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

45161

EPA

United States
Environmental Protection Agency
Washington DC 20460

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

Original
Re-submission

1.3) Is this an
aggregate
report for
several
facilities?
(shade one)

Yes
No

1.2) Report Date (mm/dd/yy)

/

/

Anti-Dumping Program Annual Report

1.4) RY

1.5) Company ID 1.6) Page

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2.0) Facilities Represented
2.1) Facility 1

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2.2) Facility 2

2.3) Facility 3

2.4) Facility 4

2.5) Facility 5

2.6) Facility 6

2.7) Facility 7

2.8) Facility 8

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2.9) Facility 9

2.10) Facility 10 2.11) Facility 11

2.12) Facility 12 2.13) Facility 13

2.14) Facility 14

2.15) Facility 15

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2.16) Facility 16 2.17) Facility 17 2.18) Facility 18

2.19) Facility 19 2.20) Facility 20

2.21) Facility 21

2.22) Facility 22

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

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Page 1 of 3

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

45161

EPA

United States
Environmental Protection Agency
Washington DC 20460

Anti-Dumping Program Annual Report

Identifying Information (from page 1)

Page

Report Date

/

/

Facility 1

1
2
3
4
5
6
7
8
9
0

Company ID

RY

1
2
3
4
5
6
7
8
9
0

3.0) Volume Information (gals)
3.1) Total Volume of All Conventional
Gasoline Produced or Imported (gals)

,

,

,

,

1
2
3
4
5
6
7
8
9
0
4.0 Compliance Calculation Results
4.1) Applicable Exhaust
Toxics Emissions
Standard (mg/mi)

,

(Complex Model - 1998 and after)
4.3) Average Exhaust
Toxics Emissions
(mg/mi)

4.4) Applicable Exhaust
NOx Emissions
Standard (mg/mi)

.

.
1
2
3
4
5
6
7
8
9
0

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

,

1
2
3
4
5
6
7
8
9
0

4.2) Compliance Baseline
Toxics Value (MSAT)
(mg/mi)

.
1
2
3
4
5
6
7
8
9
0

3.2) Incremental Volume of all
Conventional Gasoline
Produced or Imported (MSAT)
(gals)

1
2
3
4
5
6
7
8
9
0

4.5) Average Exhaust
NOx Emissions
(mg/mi)

.

.
1
2
3
4
5
6
7
8
9
0

1
2
3
4
5
6
7
8
9
0

US Mail: U.S. E.P.A.
Commercial U.S. E.P.A.
Delivery:
Attn: REFGAS (6406J)
Attn: REFGAS; (202) 343-9038
1200 Pennsylvania Ave NW
1310 L Street, NW
Washington, DC 20460
Washington, DC 20005

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

Page 2 of 3

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

45161

EPA

United States
Environmental Protection Agency
Washington DC 20460

Anti-Dumping Program Annual Report

Identifying Information (from page 1)

Page

Report Date

/

/

Facility 1

1
2
3
4
5
6
7
8
9
0

Company ID

RY

1
2
3
4
5
6
7
8
9
0

5.0) MSAT Compliance Summary
5.1) Credit (+) or Deficit (-) Carried Forward
from Previous Year (mg/mi-gals)

5.2) Current Year's MSAT Compliance Before
Applying Credits or Deficits (mg/mi-gals)

-

-

,

,

,

,

1
2
3
4
5
6
7
8
9
0

,

,

,

,

1
2
3
4
5
6
7
8
9
0

5.3) Credit (+) or Deficit (-) to Carry Forward
into Next Year (mg/mi-gals)

-

,

,

,

,

1
2
3
4
5
6
7
8
9
0
Completed Forms are
to be submitted to
one of the following
addresses.

US Mail: U.S. E.P.A.
Commercial U.S. E.P.A.
Delivery:
Attn: REFGAS (6406J)
Attn: REFGAS; (202) 343-9038
1200 Pennsylvania Ave NW
1310 L Street, NW
Washington, DC 20460
Washington, DC 20005

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

Page 3 of 3