Schedule 501b - Terminal Operator'S Schedule Of Disbursements
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2SF# 49091
Schedule 501B
(R3 \ 12-08)
Terminal Operator’s Schedule of Disbursements
Terminal Operator Name
License Number
FEIN
Terminal Code
Month/Year
.
You may photocopy this blank schedule for future filings. Attach additional sheets if necessary
Please see the product code matrix on the Web site at
(12)
Transporter Information
Position Holder Information
(11)
Position
Position Hold-
(2)
(4)
(6)
(7)
(8)
(9)
(1)
(3)
(5)
(10)
er’s Customer
Holder’s
Name
FEIN
Mode
Destination
Name/
FEIN
Document
Document
Net
Gross
Customer
Name
State
Date
Address
Number
Gallons
Gallons
FEIN
Total
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