Form Boe-506-Po - Terminal Operator Information Report
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7BOE-506-PO (S1) REV. 3 (3-11)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
BOE USE ONLY
TERMINAL OPERATOR INFORMATION REPORT
RA-B/A
AUD
REG
REG
DUE ON OR BEFORE
RR-QS
FILE
REF
REF
YOUR ACCOUNT NO.
[
]
FOID
EFF
BOARD OF EQUALIZATION
SPECIAL TAXES AND FEES
PO BOX 942879
SACRAMENTO CA 94279-2074
READ INSTRUCTIONS
BEFORE PREPARING
TCN:
As a terminal operator, you are required to report your monthly receipts and disbursements of liquid
products to and from your approved terminal and the ending inventory of all products in the terminal.
Each terminal operator is required to file BOE-506-PO for each approved terminal.
Please check the applicable schedules that are attached to this report:
Terminal Operator Receipts - Schedule 15A
Terminal Operator Disbursements by Position Holder - Schedule 15B
Ending Inventory by Product Code - Schedule 15C
No activity to report
CERTIFICATION
I hereby consent to disclosure and authorize the BOE to release, as necessary, certain otherwise confidential
transaction information regarding volumes, invoice numbers, bills of lading, locations, dates, or method of
delivery of reportable products to any person identified by me in this report as being involved in a reported
transaction for the sole purpose of verifying the accuracy of the reportable product transaction information
concerning my transactions with such person as reported in this report.
I hereby certify that this report, including any accompanying schedules and statements, have been examined by
me and to the best of my knowledge and belief is a true, correct, and complete report.
SIGNATURE
EMAIL ADDRESS
PRINT NAME AND TITLE
TELEPHONE
DATE
(
)
Make a copy of this document and the accompanying schedules for your records.
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