Company Update Request CR-3360

OMB 2060-0277
OMB 2060-0308
OMB 2060-0637
07/15/2014 01:47 PM

Company Update Request CR-3360
ICR Example Company [6544]

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

CR-3360
Company Update
Awaiting RCO Wet Ink Signature
ICR Example Company [6544]

Created On :
Modified On :
Requested By :
Username :

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

List of Changes
- [Facility 01574, 72395]: Total Permitted Capacity changed from "60000" to "65000"
- [Facility 01574, 72395]: [Fuel 10]: Permitted Capacity changed from "60000" to "65000"
- [Facility 01574, 72395]: [Fuel 10]: Added Feedstock Code "Feedstock (Not Listed) -- Used at a Grandfathered Facility"

-

Page 1 of 6

OMB 2060-0277
OMB 2060-0308
OMB 2060-0637
07/15/2014 01:47 PM

Company Update Request CR-3360
ICR Example Company [6544]

Company Info
Basic Information
Company Name and Location
Company ID : 6544
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 : wilcox.jason@epa.gov
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 6

OMB 2060-0277
OMB 2060-0308
OMB 2060-0637
07/15/2014 01:47 PM

Company Update Request CR-3360
ICR Example Company [6544]

Facility List

ID
01574,
72395

Name
ICR Sample Facility

Type
Gas/Ethanol

Location
123 Street
Springfield, Illinois 55555
United States

84545

ICR Sample Importer

Diesel/Biodiesel

123 Drive
Springfield, Illinois 55555
United States

Legend:

Added

Updated

Removed

Unchanged

Page 3 of 6

OMB 2060-0277
OMB 2060-0308
OMB 2060-0637
07/15/2014 01:47 PM

Company Update Request CR-3360
ICR Example Company [6544]

Facility: ICR Sample Facility [01574, 72395]
Facility Type & Activities

Facility Type
Gas/Ethanol
Description of Aggregated Distribution System

Facility Activities
[72395] Renewable Fuel Producer
[01574] Refiner
[72395] Ethanol Producer

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 : icrsampleemail@sampleemail.g
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 6

OMB 2060-0277
OMB 2060-0308
OMB 2060-0637
07/15/2014 01:47 PM

Company Update Request CR-3360
ICR Example Company [6544]

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) : 65000

:

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: (888) Feedstock (Not Listed) -- Used at a Grandfathered Facility,
10) Starch -- Corn; Co-products: (10) Wet Distillers Grains, 20) Dry Distillers
Grains

FFARS ID

Permitted Capacity Actual Peak
(gallons)
Capacity (gallons)
123456789 65000
N/A

Page 5 of 6

Company Update Request CR-3360
ICR Example Company [6544]

OMB 2060-0277
OMB 2060-0308
OMB 2060-0637
07/15/2014 01:47 PM

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

Date ______________

List of Changes
- [Facility 01574, 72395]: Total Permitted Capacity changed from "60000" to "65000"
- [Facility 01574, 72395]: [Fuel 10]: Permitted Capacity changed from "60000" to "65000"
- [Facility 01574, 72395]: [Fuel 10]: Added Feedstock Code "Feedstock (Not Listed) -- Used at a Grandfathered Facility"

-

Page 6 of 6