1350
STATE OF SOUTH CAROLINA
L-2111
DEPARTMENT OF REVENUE
(Rev. 10/5/11)
TANKWAGON IMPORTER SCHEDULE OF RECEIPTS
4199
Importer Name
License Number
FEIN
Month/Year
SCHEDULE TYPE (CIRCLE ONE)
PRODUCT TYPE (CIRCLE ONE AND ENTER % WHEN APPLICABLE)
1-A
Gallons Received User Fee Paid
065
Gasoline
072
Dyed Kerosene
D00
Dyed Biodiesel (100%)
122
Blend Components
130
Jet Fuel
B01-B99
Undyed Biodiesel
3-A
Gallons Imported Tax or User Fee Free
125
Aviation Gasoline
142
Kerosene
Blend (%
)
By Tankwagon from
E00
Fuel Grade Ethanol (100%)
167
Low Sulfur Undyed Diesel
D01-D99
Dyed Biodiesel
E01-E99
Gasohol (%
)
226
High Sulfur Dyed Diesel
Blend (%
)
227
Low Sulfur Dyed Diesel
092
Other/Substitute
B00
Undyed Biodiesel (100%)
Fuel (
)
1
2
3
4
5
6
7
8
9
10
Carrier
Carrier
Point Of
Terminal
Supplier
Supplier
Date
Document
Billed
Name
FEIN
Mode
Origin
Dest
Code
Name
FEIN
Shipped
Number
Gallons