Form R-5395 - Schedule I - Terminal Operator Schedule Of Receipts

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R-5395 (7/06)
Page_____ of _____
Schedule I
Terminal Operator Schedule of Receipts
Company Name
LA Revenue Account Number TCN
Product Type
Filing Period
Mode of Transport
Product Type (Only one product type per page)
B = Barge
PL = Pipeline
065 – Gasoline
125 – Aviation Gasoline
142 – Clear Kerosene
170 – Clear Biodiesel
J = Truck
ST = Stationary Transfer
123 – Alcohol
130 – Jet Fuel
160 – Clear Diesel
171 – Dyed Biodiesel
R = Rail
BA = Book Adjustment
124 – Gasohol
072 – Dyed Kerosene
228 – Dyed Diesel
Other ________________
S = Ship
(1)
(2)
(4)
(3)
(5)
(6)
Carrier
Position Holder
Doc.
Net
Name
FEIN
Name
FEIN
Number
Gallons
Date
Mode
Total

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Parent category: Financial
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