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APPENDIX C <br />EXAMPM I AFFIDAVIT <br />AFFIDAVIT <br />The undersigned, (name), (title) <br />arid authorized signatory of [ 1 Davis ("[ 1'°), being duly sworn, <br />states the following: <br />I have the legal capacity to make this affidavit and personal knowledge oFthe facts <br />herein. 1 make this affidavit on behalf of [ ], pursuant Co the EPA's <br />Renewable Fuel Standard regulations at 40 C.F.R. 80, t400 at seq. and CARB Low <br />Carbon Fuel Standard regulations at Cal, Code Rags. Section §§ 95480-95497. Defined <br />terms used herein shall be as defined in the Environmental Attribute Agreement entered <br />into on _, 2020 (the "Agreement"). <br />2. [oversee supply and distribution of CNG for Vehicle Fuel use at <br />3. [ ] owns and operates the following station that dispenses CNG for <br />transportation use only. <br />4. [ j entered into the Agreement with TruStar Energy LLC for the <br />ascription of Environmental Attributes to the natural gas procured and the CNG <br />dispensed For use as a Vehicle Fuel. <br />5. Pipeline quality gas procured by [ ] at the Delivery Points noted herein is <br />converted at the CNG Station into CNG for use as a transportation fuel; <br />6. At the CNG Station, the volume of natural gas withdrawn from the commercial <br />distribution system to produce CNG for use as a transportation fuel is measured by <br />continuous metering, and after such meter, the CNG is used as transportation reel and for <br />no other purpose; <br />7. On [DATE I], [XXXX] MMBtu ofBiogas-derived CNG were dispensed at the Station, as <br />evidenced by the attached unredacted utility bill A en ix 1), which sets forth the <br />volume and energy content of such Biogas. <br />8. Between [DATE2] and [DATES], [XXXX] MMBtu of such CNG, were dispensed at the <br />Station for use as Vehicle Fuel, as evidenced by the attached unredacted copy of the <br />electronic ledger (Appendix 2) and the unredacted metering data from the Station during <br />that time period (Appendix 3). <br />9. 'Neither [ ] nor any other entity has made or will make any claim or assert <br />any right to generate any environmental credit, RIN or LCFS credit on the volumes of <br />Biogas-derived CNG described herein and pursuant to the EPA's Renewable Fuel <br />Standard regulations or CARB's Low Carbon Fuel Standard regulations. <br />15 <br />