Benzene in Gasoline Regulations (SOR/97-493)

Registration Form for a Manufacturer, Blender or Importer of Gasoline

• 1 Company name

  Company address

  

  Type of primary supplier (check one or more):

  [ ] Manufacturer [ ] Blender [ ] Importer

• 2 Name and location of each refinery and typical annual volume, in m³, of each type of gasoline manufactured at each refinery:

  

  

  

  

  

• 3 Name and location of each blending facility, typical blending material(s) and typical annual volume, in m³, of each type of gasoline blended at each facility:

  (For cargo tankers, railway cars, boats, marine vessels or other mobile blending facilities, indicate only the type and number of mobile facilities and the province of operation.)

  

  

  

  

  

• 4 Each usual point and mode of importation and typical annual volume, in m³, of each type of gasoline imported:

  

  

  

  

  

• 5 Authorized official Telephone no. () -

  Title Fax no. () -

  Signature Date