Envira Fuels, LLC
Name: ________________________________________
Member # ___________________
Mailing Address:
______________________________________________
______________________________________________
______________________________________________
Phone Number: ( ) ________ - ____________ Email: __________________________
Date: __________________ Reporting year:
____________
Reporting Quarter:
____
Jan - March ____
April - June ____
July - Sept. ____
Oct - Dec
_________________________________________________________________________________________
Biodiesel Use for B100: ____
As a Fuel ____
As a Solvent ____
Other (Specify) _____________
As a Fuel - Engine Types
& Numbers:
Engine
Type ____________________________________ # of Vehicles ___________
Engine
Type ____________________________________ # of Vehicles ___________
(Continue
on back if needed)
Number of Gallons used
this Quarter: __________________________________________________
_________________________________________________________________________________________
As a Solvent:
How
used _____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(Continue
on back if needed)
Number of Gallons used
this Quarter: __________________________________________________
_________________________________________________________________________________________
Other:
How
used _____________________________________________________________________
______________________________________________________________________________
(Continue
on back if needed)
Number of Gallons used
this Quarter: __________________________________________________
_________________________________________________________________________________________
Issues or Incidents Regarding B100 Usage:
(Mechanical, Performance, and Fuel Quality)
(Continue on back if needed)
_________________________________________________________________________________________
Biodiesel Use for BXX: ____ As
a Fuel ____
As a Solvent ____
Other (Specify) ______________
BXX Blend % (i.e. 20% for B20) _________%
As a Fuel - Engine Types
& Numbers:
Engine
Type ____________________________________ # of Vehicles ___________
Engine
Type ____________________________________ # of Vehicles ___________
(Continue
on back if needed)
Number of Gallons used
this Quarter: __________________________________________________
_________________________________________________________________________________________
As a Solvent:
How
used _____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(Continue
on back if needed)
Number of Gallons used
this Quarter: __________________________________________________
_________________________________________________________________________________________
Other:
How
used _____________________________________________________________________
______________________________________________________________________________
(Continue
on back if needed)
Number of Gallons used
this Quarter: __________________________________________________
_________________________________________________________________________________________
Issues or Incidents Regarding BXX Usage:
(Mechanical, Performance, and Fuel Quality)
(Continue on back if needed)
__________________________________________________________________________________________
SEND TO:
Envira Fuels, LLC
P.O. Box 308
Monte Rio, CA 95462
707-490-6950
info@envirafuels.com
www.envirafuels.com