Texas Regional Low Reid Vapor Pressure (RVP) Gasoline Program

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					                                Texas Regional Low Reid Vapor Pressure (RVP)
                                      Gasoline Program Reporting Form

Please sign and return this Low RVP Gasoline Program Reporting Form to Mr. Guy Hoffman, Texas Commission on Environmental Quality,
MC-164, P.O. Box 13087, Austin, TX 78711-3087. If you have any questions or need assistance filling out this form, please call (512)
239-6338.

PLEASE ENTER, PRINT, OR TYPE ALL INFORMATION

COMPANY NAME:                                                                               COMPANY ID#:


                                                                  GALLONS OF                       GALLONS OF METHYL
                        TIME PERIOD
                                                               GASOLINE SUPPLIED                  TERTIRY BUTYL ETHER
                                                                                                     (MTBE) SUPPLIED

          MAY 1, 2005 - OCTOBER 1, 2005

 CERTIFICATION
 Must be signed by owner or designated representative.
 Please check applicable has/has not box within the certification statement.
 I certify that the information supplied on this form is true and accurate to the best of my knowledge. The use of MTBE in
 gasoline supplied to the affected counties from May 1, 2005 through October 1, 2005 has *          / has not
 increased on an average per gallon basis from the period of May 1 through October 1, 1998 to conform with the Texas
 Regional Low RVP Gasoline Program requirements.

 SIGNATURE: _______________________________________________________________                DATE:

 Please print name and title:

 E-MAIL ADDRESS:
 It is an offense to falsify a government document, punishable as a Class A misdemeanor up to a second degree felony, Texas
 Penal Code, Section 37.10 (1997).

 * If the average per gallon use of MTBE has increased from May 1 through October 1, 2005, you must document the basis for the
 increase and provide a sufficient explanation to demonstrate that your organization did not increase the use of MTBE during
 this period to conform with the Texas Regional Low RVP Gasoline Program requirements. If you need additional space,
 please use attachments as necessary.




TCEQ-20209
06/21/2005