Form L-2122 - Supplier Schedule Of User Fee-Paid Receipts

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STATE OF SOUTH CAROLINA
L-2122
1350
1350
DEPARTMENT OF REVENUE
(Rev. 9/8/11)
SUPPLIER SCHEDULE OF USER FEE-PAID RECEIPTS
4210
Supplier Name
License Number
FEIN
Month/Year
Schedule I
PRODUCT TYPE (CIRCLE ONE AND ENTER % WHEN APPLICABLE)
065
Gasoline
072
Dyed Kerosene
D00
Dyed Biodiesel (100%)
122
Blend Components
130
Jet Fuel
B01-B99
Undyed Biodiesel
125
Aviation Gasoline
142
Kerosene
Blend (%
)
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
11
Point Of
Carrier
Carrier
Acquired
Sellers
Date
Document
Net
Gross
Billed
Name
FEIN
Mode
Origin
Dest
From
FEIN
Received
Number
Gallons
Gallons
Gallons
Total

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