Form Dr-156 - Florida Fuel Or Pollutants Tax Application Page 6

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DR-156
R. 01/18
Page 3
15.
Carrier Information
A) Do you transport petroleum products/fuels
over the highways and/or waterways of Florida? ............. o YES ........... o NO .......................... If “ NO,” go to question 16.
If “YES,” are you a common carrier? ................................ o YES ........... o NO .......................... If “ NO,” go to question 15(B)
If “YES,” what mode of transportation
is used to transport the fuel/petroleum products?
o Truck
o Rail
o Vessel
o Pipeline
B) If you are not a common carrier, list the make/model, year, vehicle identification number, and total tanker capacity of each
truck, barge, boat, or other equipment used to transport fuel on the highways or waterways of Florida. Cab cards will be
issued for each motor vehicle or item of equipment used to transport fuel. (If necessary, attach a separate sheet.)
Make/Model
Year
Vehicle ID Number
Tanker Capacity (in Gallons)
16.
Fuel Storage Information
Answer all questions. DO NOT leave any blank.
1) Do you have a through-put agreement? ...............................................................................................o YES o NO
2) Do you deliver fuel directly to retail locations? ......................................................................................o YES o NO
3) Do you own, operate or lease any bulk storage tanks in Florida? ........................................................ o YES o NO
If “YES” to 3, list all below and indicate whether it is owned or leased:
Tank Capacity
*DEP Number
Physical Location (Address)
Own/Lease
(in Gallons)
* “DEP number” means the facility identification number assigned by the Florida Department of Environmental Protection to your location.
DEP numbers are not assigned to Natural Gas dealers. (If necessary, attach a separate sheet.)
17.
Pollutants Storage Information
Will this business produce, import, or remove petroleum pollutants through a terminal rack in Florida? o YES o NO
If “YES” (check appropriate box(es)):
Produce
Import or cause to be imported (into Florida)
Export
o
o
o
Be entitled to a refund on the following taxable pollutants:
o
Petroleum Products
Ammonia o
Pesticides o
Chlorine
o
o
Motor Oil or Other Lubricants o
Crude Oil o
Solvents
Perchloroethylene
o
o
Other (specify) ___________________________________________________________________________________
o
List the type of pollutant, location of storage facility, and estimated volume of taxable units imported, produced, or
sold in Florida.
Type of Pollutant
Location of Storage Facility
Taxable Units

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