Uniform Oil Response And Prevention Fee Monthly Return Form - State Of Rhode Island Department Of Administration Page 2
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3SCHEDULE A-1
RECEIPT OF PETROLEUM PRODUCTS SUBJECT TO UNIFORM OIL RESPONSE AND PREVENTION FEE
PRODUCT RECEIVED AND OWNED ON THE SEASIDE OF A MARINE TERMINAL WITHIN THIS STATE
Date
Name
Name
Name of Terminal
Invoice
Type of
#
of
of
of
Where Petroleum Product
Number
Petroleum
of
Receipt
Vessel
Supplier
Was Received/Delivered
Product
Barrels
TOTAL
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