Form L-2100 - Schedule 15-B - Terminal Operator Schedule Of Disbursement Page 3

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SCHEDULE 15 B
TERMINAL OPERATOR SCHEDULE OF DISBURSEMENTS
Use this schedule to list each disbursement of accountable product (see product list) remove over the rack at the terminal.
Please list all disbursements in alphabetical order by Supplier.
TERMINAL NAME AND TERMINAL FEIN
Enter the name and Federal Identification Number for the terminal operator shown on the terminal return.
TERMINAL CODE
Number issued by the Internal Revenue Service to identify the terminal in the bulk transfer/terminal distribution
system.
COLUMN 1 & 2:
Carrier - Enter the name of the company that transports the product from the terminal and the Federal
Identification number if available.
COLUMN 3:
Mode of Transport - Enter the mode of transport from the terminal. Use one of the following:
J
= Truck
R
= Rail
B = Barge
S
= Ship
PL = Pipeline
BA = Book Adjustment
ST = Stock Transfer
COLUMN 4
Destination State - Enter the state, territory, or foreign country to which any reportable motor fuel is
directed for delivery into any storage facility, receptacle, container, or any type of transportation
equipment, for the purpose of resale or use.
COLUMN 5 & 6:
Supplier - Enter the name of the company that removes the product for sale as reflected on the records
of the terminal operator and the Federal Identification Number if available.
COLUMN 7:
Date Shipped - Enter the date the carrier leaves the terminal with the product.
COLUMN 8:
Document Number - Enter the identifying number from the document issued at the terminal when
product is removed over the rack. In the case of pipeline or barge movements, enter the pipeline or
barge ticket number.
COLUMN 9:
Net Gallons - Enter the net amount of gallons withdrawn from the terminal. The total of all amounts
entered in this column should agree to the amount shown for disbursements on the terminal return
(lines 4 & 5 on form L.-2098).
COLUMN 10:
Gross Gallons - Enter the gross amount of gallons withdrawn from the terminal.
44641017
L-2100 I
(Rev. 10/10/11)
4464

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