Form Boe-506-Po - Terminal Operator Information Report Page 7
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7STATE OF CALIFORNIA
BOE-506-PO (S5) REV. 3 (3-11)
BOARD OF EQUALIZATION
SCHEDULE 15B - TERMINAL OPERATOR DISBURSEMENTS BY POSITION HOLDER
Page
of
(If additional space is needed, please photocopy the schedule before making entries.)
(a) COMPANY NAME
(b) BOE ACCOUNT NUMBER
(c) TCN
(d) PRODUCT CODE
(e) MONTH/YEAR
POSITION HOLDER (PH) NAME (enter one name per page)
PH FEIN
(1)
(4)
(6)
(8)
(2)
(3)
(5)
(7)
CARRIER
DESTINATION
DOCUMENT
GROSS
CARRIER
MODE
DOCUMENT
NET
NAME
FEIN
STATE
DATE
NUMBER
GALLONS
GALLONS
TOTAL (add amounts in columns 7 and 8 and enter the totals)
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Parent category: Financial