Form Gas-1262 - Motor Fuels Application - North Carolina Department Of Revenue - 2008 Page 9
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23Part 3. Business Operations Information
***List the type(s) of license for which you are applying. Complete the section(s) below for license type(s) requested. (See instructions.)***
Refiner License
List Federal 637 Number:
Yes
No
1. Do you have any petroleum product refining capabilities? List each state.
2. List the locations of all refineries in North Carolina from which you intend to refine petroleum products. (Attach additional
sheets if necessary.)
3. Estimated monthly gallons of refined petroleum products disbursed from in-state refineries only.
Dyed
Gasoline
Methanol
Kerosene
Low Sulfur
Jet Fuel
Alcohol
Diesel
High Sulfur
Aviation
Propane
Diesel
Gasoline
Undyed
Undyed
Ethanol
Kerosene
Biodiesel
Dyed
Yes
No
4. Do you lease storage facilities in a terminal in North Carolina?
Biodiesel
5. From whom and where do you lease the storage facilities? (Attach additional sheets if necessary.)
Yes
No
6. Do you plan to import petroleum products into North Carolina?
7. Indicate the type of petroleum products imported into North Carolina.
Gasoline
Undyed Kerosene
Aviation Gasoline
Alcohol
Low Sulfur Diesel
Dyed Kerosene
Ethanol
Propane
High Sulfur Diesel
Jet Fuel
Methanol
Undyed Biodiesel
Dyed Biodiesel
8. Indicate the means of transport for this imported product.
Seagoing Vessel/Barge
Transport Truck
Tank Wagon
Pipeline
Railroad Tank Car
Other - Describe
9. List the states from which you import petroleum products and your license number in those states. (Attach additional sheets if necessary.)
Yes
No
10. Do you plan to export petroleum products out of North Carolina?
11. Indicate the type of petroleum products exported from this state.
Gasoline
Undyed Kerosene
Aviation Gasoline
Alcohol
Low Sulfur Diesel
Dyed Kerosene
Ethanol
Propane
High Sulfur Diesel
Jet Fuel
Methanol
Undyed Biodiesel
Dyed Biodiesel
List Federal 637 Number:
Terminal Operator License
Yes
No
12. Do you own or operate a terminal in North Carolina?
Yes
No
13. Do you own or operate a terminal in another state from which petroleum products are delivered to North Carolina?
14. List the physical terminal address, along with the federal terminal control number (TCN), for each terminal selling petroleum
product with a North Carolina destination. (Attach additional sheets if necessary.)
15. List all position holders/suppliers owning product in your terminal(s). (Attach additional sheets if necessary.)
Page 8
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