Renewable Fuel Standard O M B C ontro l No . 2060 -0688 RFS Independent Third- Party Mass Balance Expires 12/31/2017 Report Form ID: RFS2 4 00

EPA Form No. 5900 - 361 Page **1** of **4 RFS**  **Independent Third Party Mass Balance**  **( RF**  **S 2**  **4 00**  **): Instructions for Completing Who must report**   All independent third-party auditors that verify RINs beginning on September 16, 2014. **Reporting requirements**  Complete this report representing all mass and energy balances calculated as a single entry for the compliance quarter.  40 CFR 80.1451( g)(2 ) sets forth the additional reporting requirements (available at : http://www.ecfr.gov/cgi
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idx?SID=354294fee688f6d54979e2638c0decf5&node=se40.17.80_11451&rgn=div8 ).  **Required fields and NA values**

– Certain report fields or parameters may be specific to select product types. If a report field does not apply to the reported batch, enter the value “NA”. Do not leave the field blank. **Reporting deadlines**  Independent third-party auditors shall report on a quarterly basis :

Production Calendar Quarter Time Period Covered Quarterly Report Deadline Quarter 1 January 1

– March 31 Ju ne 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 http://www.epa.gov/otaq/fuels/reporting/cdx.htm**. Field**  **Instructions** Field No. Field Name Units Field Formats, Codes & Special Instructions 1 Report Form ID **AAAAAA** ; Character . Enter **RF S2**  **4 00**  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.Renewable Fuel Standard O M B C ontro l No . 2060 -0688 RFS Independent Third- Party Mass Balance Expires 12/31/2017 Report Form ID: RFS2 4 00

EPA Form No. 5900 - 361 Page **2** of **4** Field No. Field Name Units Field Formats, Codes & Special Instructions 5 Compliance Period Year **YYYY** ; Character . Enter the averaging/compliance year the report covers. 6 Compliance Period Quarter **AA;** Character. Enter the quarter under the compliance year this report covers : **Q1:** Quarter 1 (January

– March) **Q2:** Quarter 2 (April

– June) **Q3:** Quarter 3 (July

– September) **Q4:** Quarter 4 (October

– December) 7 Independent ThirdParty Auditor Company ID **AAAA** ; Character . Enter the EPA assigned fourcharacter ID for the Independent Third Party Auditor . 8 Independent ThirdParty Auditor Company Name **AAAA...;** Character . Enter the registered name of the Independent Third-Party Auditor 9 Verified Renewable Fuel Producer Company Name **AAAA...;** Character . Enter the registered name of the renewable fuel producer audited under an approved QAP under 80.1469. 10 Verified Renewable Fuel Producer Company ID **AAAA ;**  Character . Enter the four digit company ID of the renewable fuel producer audited under an approved QAP under 80.1469. 11 Verified Renewable Fuel Producer Facility ID **AAAAA ;**  Character . Enter the five digit facility ID of the renewable fuel production facility audited under an approved QAP under 80.1469. 12 Feedstock (value) **999999999999;** Number . Enter the total numerical value of feedstock used as an input in the production process. 13 Feedstock (unit) **AAAAAA;** Character (25 character limit) Enter the unit of measure specific to the feedstock value. 14 Chemicals (value) **999999999999;** Number . Enter the total numerical value of chemicals used as an input in the production process. 15 Chemicals (unit) **AAAAAA;** Character (25 character limit) Enter the unit of measure specific to the chemicals value. If none, enter “NA”. 16 Others (value) **999999999999;** Number . Enter the total numerical value of other substance/material used which is not accounted for under the feedstock or chemical totals, as an input in the production process. 17 Others (unit) **AAAAAA;** Character (25 character limit) Enter the unit of measure specific to the other substance/material used as an input in the production process. If none, enter “NA”. 18 Fuel Produced (value) **999999999999;** Number . Enter the total amount of renewable fuel producedRenewable Fuel Standard O M B C ontro l No . 2060 -0688 RFS Independent Third- Party Mass Balance Expires 12/31/2017 Report Form ID: RFS2 4 00

EPA Form No. 5900 - 361 Page **3** of **4** Field No. Field Name Units Field Formats, Codes & Special Instructions 19 Fuel Produced (unit) **AAAAAA;** Character (25 character limit) Enter the unit of measure specific to the amount of renewable fuel produced. 20 Co -Products (value) **999999999999;** Number . Enter the total amount of co products produced. 21 Co -Products (unit) **AAAAAA;** Character (25 character limit) Enter the unit of measure specific to the co -products produced. If none, enter “NA”. 22 Waste Material (value) **999999999999;** Number . Enter the total amount of waste material. 23 Waste Material (unit) **AAAAAA;** Character (25 character limit) Enter the unit of measure specific to the waste material. If none, enter “NA”. 24 Other (value) **999999999999;** Number . Enter the total amount of other substances produced not accounted for under the other outputs. 25 Other (unit) **AAAAAA;** Character (25 character limit) Enter the unit of measure specific to other substances produced. If none, enter “NA”. 26 Purchased Electricity (value) **999999999999;** Number . Enter the total amount of purchased electricity used as an energy input . 27 Purchased Electricity (unit) **AAAAAA;** Character (25 character limit)
. Enter the unit of measure specific to purchased electricity. If none, enter “NA”. 28 Purchased Steam or Hot Water (value) **999999999999;** Number . Enter the total amount of purchased steam or hot water used as an energy input . 29 Purchased Steam or Hot Water (unit) **AAAAAA;** Character (25 character limit)
. Enter the unit of measure specific to purchased steam or hot water. If none, enter “NA”. 30 Coal (value) **999999999999;** Number . Enter the total amount of coal used as an energy input. 31 Coal (unit) **AAAAAA;** Character (25 character limit)
. Enter the unit of measure to specific to coal used as an energy input. If none, enter “NA”. 32 Natural Gas (value) **999999999999;** Number . Enter the total amount of natural gas used as an energy input. 33 Natural Gas (unit) **AAAAAA;** Character (25 character limit)
. Enter the unit of measure specific to natural gas used as an energy input. If none, enter “NA”. 34 Diesel (value) **999999999999;** Number . Enter the total amount of diesel used as an energy input. 35 Diesel (unit) **AAAAAA;** Character (25 character limit)
. Enter the unit of measure specific to diesel used as an energy input. If none, enter “NA”. 36 CHP (value) **999999999 999;**  Number . Enter the total amount of CHP used as an energy input.Renewable Fuel Standard O M B C ontro l No . 2060 -0688 RFS Independent Third- Party Mass Balance Expires 12/31/2017 Report Form ID: RFS2 4 00

EPA Form No. 5900 - 361 Page **4** of **4** Field No. Field Name Units Field Formats, Codes & Special Instructions 37 CHP (unit) **AAAAAA;** Character (25 character limit)
. Enter the unit of measure specific to CHP used as an energy input. If none, enter “NA”. 38 Other (value) **999999999999;** Number . Enter the total amount of other substance material used that was not accounted for under the other energy inputs. If none, enter “NA”. 39 Other (unit) **AAAAAA;** Character (25 character limit)
. Enter the unit of measure specific to other substance material used as an energy input. 40 Excess Electricity Generated (value) **999999999999;** Number . Enter the total amount of excess electricity generated as an output of the production process. If none, enter “NA”. 41 Excess Electricity Generated (unit) **AAAAAA;** Character (25 character limit)
. Enter the unit of measure specific to the amount of excess electricity generated. If none, enter “NA”. 42 Other (value) **999999999999;** Number . Enter the total amount of other energy outputs not accounted for under excess el ectricity generated. 43 Other (unit) **AAAAAA;** Character (25 character limit ). Enter the unit of measure specific to the total amount of other energy outputs. If none, enter “NA”. 44 Comment **AAA...;** Character (500 character limit)
. Optional field , enter any comments or additional information on calculations as needed. Paperwork Reduction Act Statement The public reporting and recordkeeping burden for this collection of information is disclosed in the estimates of the individual report form instructions. Burden means the total time, effort, or financial resources expended by persons to generate, maintain, retain, or disclose or provide information to or for a Federal agency. This includes the time needed to review instructions; develop, acquire, install, and utilize technology and systems for the purposes of collecting, validating, and verifying information, processing and maintaining information, and disclosing and providing information; adjust the existing ways to comply with any previously applicable instructions and requirements; train personnel to be able to respond to a collection of information; search data sources; complete and review the collection of information; and transmit or otherwise disclose the information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.