Form Reg-8-A - Motor Fuel And Other Fuel Information (Distributor, Supplier, Receiver, Or Blender) Page 2

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7
Do you intend to import motor fuel or other fuels into Illinois?
Yes
No
If yes, how often?
___________________
List all product types you intend to import: ___________________________________________________________________________
List the states you intend to import from: ____________________________________________________________________________
8 Do you intend to export motor fuel or other fuels from Illinois?
Yes
No
If yes, how often?
___________________
List the products you intend to export:
_______________________________________________________________________________
List the states you intend to export to:
_______________________________________________________________________________
9 Will you blend: Yes
No
; compound: Yes
No
; manufacture: Yes
No
motor fuel/other fuels?
If you intend to blend with alcohol, give the name of your alcohol supplier.
_________________________________________________________
If you intend to blend with soy, give the name of your soy supplier.
________________________________________________________________
1 0 Tell us if your only activity with respect to motor fuel/other fuels is:
production of alcohol in quantities of less than 10,000 proof gallons per year
; or,
blending alcohol in quantities of less than 10,000 proof gallons per year
.
1 1 Estimated number of gallons of motor fuel to be blended monthly.
Gasoline
________________ Special fuel ________________ Dyed Diesel ________________
Other
__________________
(specify) _
1 2 If you blend, estimate the number of gallons of blending agent(s) to be blended monthly.
Alcohol/Ethanol ________________ Soy/Biodiesel ________________ 1-K ________________ Other
___________________
(specify)
1 3
Give a detailed description of the products to be used for blending.
________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
1 4
Give a detailed description of the blending process used.
________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
15 Identify the location and equipment used for blending. __________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
1 6
Once blended, what do you intend to do with the blended product(s)?
______________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
1 7 Tell us how you receive your motor fuel or other fuel.
(Attach additional sheets if necessary.)
Types of
transportation
Location of receipt (city and state)
Carrier owned/hired by your company
Carrier owned/hired by your supplier
Tank car (rail)
______________________________________
owned
hired
owned
hired
______________________________________
owned
hired
owned
hired
______________________________________
owned
hired
owned
hired
Transport (truck)
______________________________________
owned
hired
owned
hired
______________________________________
owned
hired
owned
hired
______________________________________
owned
hired
owned
hired
Barge
______________________________________
owned
hired
owned
hired
Pipeline
______________________________________
owned
hired
owned
hired
Other
______________________________________
owned
hired
owned
hired
Page 2
REG-8-A (R-03/13)

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