Form Sf# 49091 - Schedule 501b Terminal Operator'S Schedule Of Disbursements 2007

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SF# 49091
Schedule 501B
(R2\05-07)
Terminal Operator’s Schedule of Disbursements
Terminal Operator Name
License Number
FEIN
Terminal Code
Month/Year
You may photocopy this blank schedule for future fi lings. Attach additional sheets if necessary.
Product Code/Type (Check One)
For Use with Reporting Special Fuel
For Use with Reporting Gasoline/Oil Inspection
142
Kerosene
065
Gasoline
160
Diesel Fuel - clear
124
Gasohol
170
Biodiesel - undyed (blended product)
125
Aviation Fuel
171
Biodiesel - dyed (blended product)
130
Jet Fuel
228
Diesel Fuel - dyed
142
Kerosene
B00
Biodiesel (B-100) - undyed
150
#1 Fuel Oil - undyed
D00
Biodiesel (B-100) - dyed
161
Low Sulfur Diesel #1 - undyed
OTH
Other (specify)
231
No. 1 Diesel - dyed
167
Low Sulfur Diesel #2 - undyed
E00
Ethanol - (100%)
161
Low Sulfur Diesel #1 - undyed
E85
85% Ethanol / 15% Gasoline
M00
Methanol - (100%)
OTH
Other (specify)
Transporter Information
Position Holder Information
(11)
(12)
Position Hold-
Position
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Holder’s
er’s Customer
FEIN
Destination
FEIN
Document
Document
Net
Name
Mode
Name/
Gross
Customer
Name
State
Date
Address
Number
Gallons
Gallons
FEIN
Total

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