STATE OF CALIFORNIA
BOE-501-IR (FRONT) REV. 4 (4-13)
BOARD OF EQUALIZATION
BOE USE ONLY
CALIFORNIA OIL SPILL RESPONSE FEE ANNUAL INFORMATION RETURN
RA-B/A
AUD
REG
DUE ON OR BEFORE
RR-QS
FILE
REF
YOUR ACCOUNT NO.
[
]
FOID
EFF
BOARD OF EQUALIZATION
SPECIAL TAXES AND FEES
PO BOX 942879
SACRAMENTO CA 94279-0030
READ INSTRUCTIONS
BEFORE PREPARING
Make changes if name
or address is incorrect.
GENERAL INFORMATION
The State Board of Equalization (BOE) is responsible for collecting fees and information under the Lempert-
Keene-Seastrand Oil Spill Prevention and Response Act. Revenue and Taxation Code, section 46151 (c) requires the
filing of annual information returns.
FILING REQUIREMENTS
Marine Terminal Operators. You are required to complete and file this form to report to the BOE: (1) the number of
barrels of petroleum products received at a marine terminal within this state by means of vessel arriving from a point
of origin outside this state; and (2) the number of barrels of crude oil that are transported from within this state by
means of marine vessel or barge to a destination outside this state.
Pipeline Operators. You are required to complete and file this form to report to the BOE: (1) the number of barrels
of petroleum products transported into the state by means of pipelines operating across, under, or through the
marine waters of this state; and (2) the number of barrels of crude oil transported out of the state by pipeline.
Refinery Operators. You are required to complete and file this form to report to the BOE the number of barrels of
crude oil received at a refinery within this state.
Note: This annual return covers a one-year calendar period and must be filed on or before the due date shown
above. The return must be filed even if you have no barrels to report during this reporting period. No fee is due with
this return.
BARRELS
CRUDE OIL
PETROLEUM PRODUCTS
TOTAL
1. Crude oil received at a refinery within this state
1.
2. Petroleum products received at a marine terminal by
2.
vessel from a point of origin outside this state
Petroleum products transported into the state by means
3.
3.
of a pipeline over, through, or under marine waters
Crude oil transported from a marine terminal by means
4.
4.
of marine vessel to a destination outside this state
Crude oil transported by a pipeline operator to a
5.
5.
destination outside this state
6. TOTAL BARRELS (add lines 1 through 5)
6.
EMAIL ADDRESS
I hereby certify that this return, including any accompanying schedules and statements, has been
examined by me and to the best of my knowledge and belief is a true, correct, and complete return.
SIGNATURE
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DATE
(
)
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