Page 1
Florida Department of Revenue Business Technology Office [email protected]
Terminal Operator Test Script
Licensed terminal operators must begin filing electronically with the Florida Department of Revenue
within 90 days of notification by the Department. New terminal operators are required to
successfully submit test files to the Department before filing electronically.
The testing process begins after completion of all registration requirements and receipt of an electronic
filer 90‐day notice from the Department. The purpose of testing is to verify that your electronic filing
system is mapping data correctly to produce valid tax returns. Testing procedures are outlined in the
Motor Fuels Technical EDI Implementation Guide.
Taxpayers who do not have transactional detail (i.e., file zero returns) should use the following test
return to create an electronic test file. When creating a test file, the following areas should contain your
actual business information:
• FEI Number
• Company/ Business Name
• License Number
• Current Collection Period Ending
Once you have created an electronic test file, upload it to the SecureNet website as “Test Only.” The
Department will compare your electronic submission against our test return and provide results in an
email.
Taxpayers who have transactional detail (receipts or disbursements) should not use this test return.
Instead, produce two electronic returns containing the data from two reporting period paper returns.
Upload the electronic files to the SecureNet website as “Test Only.” The Department will compare the
electronically filed test returns against the paper returns submitted for the same reporting periods.
If you are unable to complete your testing process within 90 days, you may ask for an extension of time
by submitting a written request to [email protected] .
If you have any questions or need assistance, please email us at [email protected] .
Page 2
COMPLETE and MAIL with your RETURN
FEIN
ENTER BUSINESS NAME:
Terminal Operator Information Return Coupon DR-309636
R. 01/14
YYM M D D
Terminal Operator Information Return
DR-309636
COMPLETE FORM DR-309636BEFORE ENTERING INFORMATION
ON THE ATTACHED COUPON.
Mail To:Florida Department of Revenue5050 W Tennessee StTallahassee FL 32399-0165
FOR PERIOD
ENDING
Mail the original of this form along with coupon
to the:
Florida Department of Revenue
5050 W Tennessee St
Tallahassee FL 32399-0165
Detach
hereDetach
here
Do Not Write in the Space Below.
IMPORTANTComplete and return
coupon to the Departmentof Revenue.
0 1 2 3 4 5 6 7 8 9 0123456789Use black ink.
Handwritten Example Typed Example
DR-309636
R. 01/14
TC
Rule 12B-5.150
Florida Administrative Code
Effective 01/14
Name
Address
City/St/ZIP
For Calendar Year:
For Calendar Year:
2017
2017
9200 0 20179999 0090027036 4 3000000001 0000 2
dr309636 testscript Pg. 2
Test S
cript
Page 3
DR-309636
R. 01/14
dr309636 testscript Pg. 3
Two pages have been added to this document
A header page that provides testing information and this discription page
The following pages have intentionally been omitted from this document
Page 2 - blank pagePages 6 and 8 - continuation of schedules
Test S
cript
Page 4
Terminal Operator
Information Return
DR-309636
R. 01/14
Under penalty of perjury, I declare that I have read this return and the facts stated in it are true.
_______________________________________________________________________________________________________________________Signature of Terminal Operator Title Date
_______________________________________________________________________________________________________________________Name of Preparer (Print) Signature of Preparer Telephone Number FEIN Date
Name of Terminal Location of Terminal
Complete Reverse Side of Return First
Check here if filing a supplemental return
Mail To:Florida Department of Revenue5050 W Tennessee StTallahassee FL 32399-0165
Return Due By Late After
FEIN: (active terminal operator)
License Number:
Collection Period Ending: (current collection period ending)
IRS Terminal Code Number
DOR USE ONLY
POSTMARK OR HAND-DELIVERY DATE
For Calendar Year:
920002017999900900270364300000000100002
2017
dr309636 testscript Pg. 4
Test S
cript
Page 5
Reconciliation of inventories for Florida terminals and refineries of all fuel transactions for the month/year entered below
1. Beginning inventory of all products:
(from last month’s return) .................
2. Total receipts during month: ...........
3. Total gallons available:
(Line 1 plus Line 2) ...........................
4. Total disbursements: ......................
5. Book inventory:
(Line 3 minus Line 4) ........................
6. Inventory discrepancies: [Enter
Line 5 minus Line 7. If Line 5
exceeds Line 7, indicate the
shortage with ( ).]. ..........................
7. Actual ending inventory of all
products: (to next month’s return) ....
DR-309636
R. 01/14
GALLONS
From
Schedule
DIESEL
A. Gasoline B. Undyed C. Dyed D. Aviation
Schedule
15A
Schedule
15B
Company Name FEIN Collection Period Ending
(mm/dd/yy)
Report receipts and disbursments in whole net gallons
2,700
1,800 2,400
dr309636 testscript Pg. 5
2,000 3,000 4,000 5,000
1,800 3,600 2,700
4,700 4,800 7,600 7,7001,200 1,800
2,900 3,600 5,200 5,900
8001,100500800
2,100 3,100 4,100 5,100
Test S
cript
Page 6
Te
rmin
al O
pe
rato
r -
Sc
he
du
le o
f R
ec
eip
ts
Pro
du
ct
Typ
e:
DR
-30
96
36
R.
01
/14
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Term
inal
Sup
plie
r
(5)
Term
inal S
up
plie
r
FE
IN
(6)
Date
Receiv
ed
(7)
Do
cu
men
t
Nu
mb
er
(8)
Net
Gallo
ns
(9)
Gro
ss
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
15
A/
065
J Te
st 1
200
300
400
Test
2
Test
3
R B
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
We H
aul It
All
We H
aul It
All
We H
aul It
All
dr30
9636
tests
cript
Pg.
6
65-9
8765
43 T
est S
uppl
ier
Test
Sup
plier
Test
Sup
plier
900
03/01
/2017
03/02
/2017
03/03
/2017
Test
Ope
rato
rT5
9FL2
116
6598
7654
303
/31/20
17
Test S
cript
Page 7
Te
rmin
al O
pe
rato
r -
Sc
he
du
le o
f R
ec
eip
ts
Pro
du
ct
Typ
e:
DR
-30
96
36
R.
01
/14
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Term
inal
Sup
plie
r
(5)
Term
inal S
up
plie
r
FE
IN
(6)
Date
Receiv
ed
(7)
Do
cu
men
t
Nu
mb
er
(8)
Net
Gallo
ns
(9)
Gro
ss
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
15
A/ 124
PLTe
st 4
200
300
400
Test
5
Test
6
S ST
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
We H
aul It
All
We H
aul It
All
We H
aul It
All
900
dr30
9636
tests
cript
Pg.
7
65-9
8765
43 T
est S
uppl
ier
Test
Sup
plier
Test
Sup
plier
03/01
/2017
03/02
/2017
03/03
/2017
Test
Ope
rato
rT5
9FL2
116
6598
7654
303
/31/20
17
Test S
cript
Page 8
Te
rmin
al O
pe
rato
r -
Sc
he
du
le o
f R
ec
eip
ts
Pro
du
ct
Typ
e:
DR
-30
96
36
R.
01
/14
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Term
inal
Sup
plie
r
(5)
Term
inal S
up
plie
r
FE
IN
(6)
Date
Receiv
ed
(7)
Do
cu
men
t
Nu
mb
er
(8)
Net
Gallo
ns
(9)
Gro
ss
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
15
A/
E00
BATe
st 7
200
300
400
Test
8
Test
9
J R
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
We H
aul It
All
We H
aul It
All
We H
aul It
All
90
0dr
3096
36 te
stscr
ipt P
g. 8
65-9
8765
43 T
est S
uppl
ier
Test
Sup
plier
Test
Sup
plier
03/01
/2017
03/02
/2017
03/03
/2017
Test
Ope
rato
rT5
9FL2
116
6598
7654
303
/31/20
17
Test S
cript
Page 9
Te
rmin
al O
pe
rato
r -
Sc
he
du
le o
f R
ec
eip
ts
Pro
du
ct
Typ
e:
DR
-30
96
36
R.
01
/14
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Term
inal
Sup
plie
r
(5)
Term
inal S
up
plie
r
FE
IN
(6)
Date
Receiv
ed
(7)
Do
cu
men
t
Nu
mb
er
(8)
Net
Gallo
ns
(9)
Gro
ss
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
15
A/
167
PLTe
st 10
200
300
400
Test
11
Test
12
S ST
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
We H
aul It
All
We H
aul It
All
We H
aul It
All
900
dr30
9636
tests
cript
Pg.
9
65-9
8765
43 T
est S
uppl
ier
Test
Sup
plier
Test
Sup
plier
03/01
/2017
03/02
/2017
03/03
/2017
Test
Ope
rato
rT5
9FL2
116
6598
7654
303
/31/20
17
Test S
cript
Page 10
Te
rmin
al O
pe
rato
r -
Sc
he
du
le o
f R
ec
eip
ts
Pro
du
ct
Typ
e:
DR
-30
96
36
R.
01
/14
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Term
inal
Sup
plie
r
(5)
Term
inal S
up
plie
r
FE
IN
(6)
Date
Receiv
ed
(7)
Do
cu
men
t
Nu
mb
er
(8)
Net
Gallo
ns
(9)
Gro
ss
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
15
A/
B00
PLTe
st 13
200
300
400
Test
14
Test
15
S ST
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
We H
aul It
All
We H
aul It
All
We H
aul It
All
900
dr30
9636
tests
cript
Pg.
10
65-9
8765
43 T
est S
uppl
ier
Test
Sup
plier
Test
Sup
plier
03/01
/2017
03/02
/2017
03/03
/2017
Test
Ope
rato
rT5
9FL2
116
6598
7654
303
/31/20
17
Test S
cript
Page 11
Te
rmin
al O
pe
rato
r -
Sc
he
du
le o
f R
ec
eip
ts
Pro
du
ct
Typ
e:
DR
-30
96
36
R.
01
/14
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Term
inal
Sup
plie
r
(5)
Term
inal S
up
plie
r
FE
IN
(6)
Date
Receiv
ed
(7)
Do
cu
men
t
Nu
mb
er
(8)
Net
Gallo
ns
(9)
Gro
ss
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
15
A/ 226
PLTe
st 16
200
300
400
Test
17
Test
18
S ST
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
We H
aul It
All
We H
aul It
All
We H
aul It
All
900
dr30
9636
tests
cript
Pg.
11
65-9
8765
43 T
est S
uppl
ier
Test
Sup
plier
Test
Sup
plier
03/01
/2017
03/02
/2017
03/03
/2017
Test
Ope
rato
rT5
9FL2
116
6598
7654
303
/31/20
17
Test S
cript
Page 12
Te
rmin
al O
pe
rato
r -
Sc
he
du
le o
f R
ec
eip
ts
Pro
du
ct
Typ
e:
DR
-30
96
36
R.
01
/14
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Term
inal
Sup
plie
r
(5)
Term
inal S
up
plie
r
FE
IN
(6)
Date
Receiv
ed
(7)
Do
cu
men
t
Nu
mb
er
(8)
Net
Gallo
ns
(9)
Gro
ss
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
15
A/ 227
PLTe
st 19
200
300
400
Test
20
Test
21
S ST
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
We H
aul It
All
We H
aul It
All
We H
aul It
All
900
dr30
9636
tests
cript
Pg.
12
65-9
8765
43 T
est S
uppl
ier
Test
Sup
plier
Test
Sup
plier
03/01
/2017
03/02
/2017
03/03
/2017
Test
Ope
rato
rT5
9FL2
116
6598
7654
303
/31/20
17
Test S
cript
Page 13
Te
rmin
al O
pe
rato
r -
Sc
he
du
le o
f R
ec
eip
ts
Pro
du
ct
Typ
e:
DR
-30
96
36
R.
01
/14
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Term
inal
Sup
plie
r
(5)
Term
inal S
up
plie
r
FE
IN
(6)
Date
Receiv
ed
(7)
Do
cu
men
t
Nu
mb
er
(8)
Net
Gallo
ns
(9)
Gro
ss
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
15
A/ 072
PLTe
st 22
200
300
400
Test
23
Test
24
S ST
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
We H
aul It
All
We H
aul It
All
We H
aul It
All
900
dr30
9636
tests
cript
Pg.
13
65-9
8765
43 T
est S
uppl
ier
Test
Sup
plier
Test
Sup
plier
03/01
/2017
03/02
/2017
03/03
/2017
Test
Ope
rato
rT5
9FL2
116
6598
7654
303
/31/20
17
Test S
cript
Page 14
Te
rmin
al O
pe
rato
r -
Sc
he
du
le o
f R
ec
eip
ts
Pro
du
ct
Typ
e:
DR
-30
96
36
R.
01
/14
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Term
inal
Sup
plie
r
(5)
Term
inal S
up
plie
r
FE
IN
(6)
Date
Receiv
ed
(7)
Do
cu
men
t
Nu
mb
er
(8)
Net
Gallo
ns
(9)
Gro
ss
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
15
A/ D0
0
PLTe
st 25
200
300
400
Test
26
Test
27
S ST
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
We H
aul It
All
We H
aul It
All
We H
aul It
All
900
dr30
9636
tests
cript
Pg.
14
65-9
8765
43 T
est S
uppl
ier
Test
Sup
plier
Test
Sup
plier
03/01
/2017
03/02
/2017
03/03
/2017
Test
Ope
rato
rT5
9FL2
116
6598
7654
303
/31/20
17
Test S
cript
Page 15
Te
rmin
al O
pe
rato
r -
Sc
he
du
le o
f R
ec
eip
ts
Pro
du
ct
Typ
e:
DR
-30
96
36
R.
01
/14
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Term
inal
Sup
plie
r
(5)
Term
inal S
up
plie
r
FE
IN
(6)
Date
Receiv
ed
(7)
Do
cu
men
t
Nu
mb
er
(8)
Net
Gallo
ns
(9)
Gro
ss
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
15
A/ 125
PLTe
st 28
200
300
400
Test
29
Test
30
S ST
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
We H
aul It
All
We H
aul It
All
We H
aul It
All
900
dr30
9636
tests
cript
Pg.
15
65-9
8765
43 T
est S
uppl
ier
Test
Sup
plier
Test
Sup
plier
03/01
/2017
03/02
/2017
03/03
/2017
Test
Ope
rato
rT5
9FL2
116
6598
7654
303
/31/20
17
Test S
cript
Page 16
Te
rmin
al O
pe
rato
r -
Sc
he
du
le o
f R
ec
eip
ts
Pro
du
ct
Typ
e:
DR
-30
96
36
R.
01
/14
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Term
inal
Sup
plie
r
(5)
Term
inal S
up
plie
r
FE
IN
(6)
Date
Receiv
ed
(7)
Do
cu
men
t
Nu
mb
er
(8)
Net
Gallo
ns
(9)
Gro
ss
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
15
A/ 130
PLTe
st 31
200
300
400
Test
32
Test
33
S ST
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
We H
aul It
All
We H
aul It
All
We H
aul It
All
900
dr30
9636
tests
cript
Pg.
16
65-9
8765
43 T
est S
uppl
ier
Test
Sup
plier
Test
Sup
plier
03/01
/2017
03/02
/2017
03/03
/2017
Test
Ope
rato
rT5
9FL2
116
6598
7654
303
/31/20
17
Test S
cript
Page 17
Te
rmin
al O
pe
rato
r -
Sc
he
du
le o
f R
ec
eip
ts
Pro
du
ct
Typ
e:
DR
-30
96
36
R.
01
/14
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Term
inal
Sup
plie
r
(5)
Term
inal S
up
plie
r
FE
IN
(6)
Date
Receiv
ed
(7)
Do
cu
men
t
Nu
mb
er
(8)
Net
Gallo
ns
(9)
Gro
ss
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
15
A/ 142
PLTe
st 34
200
300
400
Test
35
Test
36
S ST
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
65-9
8765
43
We H
aul It
All
We H
aul It
All
We H
aul It
All
900
dr30
9636
tests
cript
Pg.
17
65-9
8765
43 T
est S
uppl
ier
Test
Sup
plier
Test
Sup
plier
03/01
/2017
03/02
/2017
03/03
/2017
Test
Ope
rato
rT5
9FL2
116
6598
7654
303
/31/20
17
Test S
cript
Page 18
Pro
du
ct
Typ
e:
Sc
he
du
le o
f D
isb
urs
em
en
ts -
Te
rmin
al O
pe
rato
r
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B
00
Und
yed
/Unb
lend
ed
Bio
die
sel
(B100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
DR
-30
96
36
R.
01
/14
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Dest.
Sta
te
(5)
Term
inal
Sup
plie
r
(6)
Term
inal S
up
plie
r
FE
IN
(7)
Date
Sh
ipp
ed
(8)
Do
cu
men
t
Nu
mb
er
(9)
Net
Gallo
ns
(10
)G
ross
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
15
B/
065
We H
aul It
All
We H
aul It
All
We H
aul It
All
65-9
8765
43
65-9
8765
43
65-9
8765
43
J R
ZZ AL
Test
Sup
plier
Test
Sup
plier
Test
37
Test
38
100
200
6
00
dr30
9636
tests
cript
Pg.
18
BGA
Te
st S
uppl
ier
65-9
8765
43
65-9
8765
43
65-9
8765
43Te
st 39
03/01
/2017
03/02
/2017
03/03
/2017
300
Test
Ope
rato
rT5
9FL2
116
6598
7654
303
/31/20
17
Test S
cript
Page 19
Pro
du
ct
Typ
e:
Sc
he
du
le o
f D
isb
urs
em
en
ts -
Te
rmin
al O
pe
rato
r
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B
00
Und
yed
/Unb
lend
ed
Bio
die
sel
(B100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
DR
-30
96
36
R.
01
/14
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Dest.
Sta
te
(5)
Term
inal
Sup
plie
r
(6)
Term
inal S
up
plie
r
FE
IN
(7)
Date
Sh
ipp
ed
(8)
Do
cu
men
t
Nu
mb
er
(9)
Net
Gallo
ns
(10
)G
ross
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
15
B/
124
We H
aul It
All
We H
aul It
All
We H
aul It
All
65-9
8765
43
65-9
8765
43
65-9
8765
43
PL S
LA AR
Test
Sup
plier
Test
Sup
plier
Test
40
Test
41
100
200
60
0
dr30
9636
tests
cript
Pg.
19
BATe
st S
uppl
ier
65-9
8765
43
65-9
8765
43
65-9
8765
43Te
st 42
03/01
/2017
03/02
/2017
03/03
/2017
300
MS
Test
Ope
rato
rT5
9FL2
116
6598
7654
303
/31/20
17
Test S
cript
Page 20
Pro
du
ct
Typ
e:
Sc
he
du
le o
f D
isb
urs
em
en
ts -
Te
rmin
al O
pe
rato
r
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B
00
Und
yed
/Unb
lend
ed
Bio
die
sel
(B100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
DR
-30
96
36
R.
01
/14
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Dest.
Sta
te
(5)
Term
inal
Sup
plie
r
(6)
Term
inal S
up
plie
r
FE
IN
(7)
Date
Sh
ipp
ed
(8)
Do
cu
men
t
Nu
mb
er
(9)
Net
Gallo
ns
(10
)G
ross
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
15
B/ E0
0
We H
aul It
All
We H
aul It
All
We H
aul It
All
65-9
8765
43
65-9
8765
43
65-9
8765
43
ST ST
ZZ TX
Test
Sup
plier
Test
Sup
plier
Test
43
Test
44
100
200
60
0
dr30
9636
tests
cript
Pg.
20
STTe
st S
uppl
ier
65-9
8765
43
65-9
8765
43
65-9
8765
43Te
st 45
03/01
/2017
03/02
/2017
03/03
/2017
300
SC
Test
Ope
rato
rT5
9FL2
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7654
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17
Test S
cript
Page 21
Pro
du
ct
Typ
e:
Sc
he
du
le o
f D
isb
urs
em
en
ts -
Te
rmin
al O
pe
rato
r
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B
00
Und
yed
/Unb
lend
ed
Bio
die
sel
(B100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
DR
-30
96
36
R.
01
/14
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Dest.
Sta
te
(5)
Term
inal
Sup
plie
r
(6)
Term
inal S
up
plie
r
FE
IN
(7)
Date
Sh
ipp
ed
(8)
Do
cu
men
t
Nu
mb
er
(9)
Net
Gallo
ns
(10
)G
ross
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
15
B/ 167
We H
aul It
All
We H
aul It
All
We H
aul It
All
65-9
8765
43
65-9
8765
43
65-9
8765
43
B S
FL FL
Test
Sup
plier
Test
Sup
plier
Test
46
Test
47
100
200
STTe
st S
uppl
ier
65-9
8765
43
65-9
8765
43
65-9
8765
43Te
st 48
03/01
/2017
03/02
/2017
03/03
/2017
300
FL
Test
Ope
rato
rT5
9FL2
116
6598
7654
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17
6
00
dr30
9636
tests
cript
Pg.
21
Test S
cript
Page 22
Pro
du
ct
Typ
e:
Sc
he
du
le o
f D
isb
urs
em
en
ts -
Te
rmin
al O
pe
rato
r
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B
00
Und
yed
/Unb
lend
ed
Bio
die
sel
(B100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
DR
-30
96
36
R.
01
/14
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Dest.
Sta
te
(5)
Term
inal
Sup
plie
r
(6)
Term
inal S
up
plie
r
FE
IN
(7)
Date
Sh
ipp
ed
(8)
Do
cu
men
t
Nu
mb
er
(9)
Net
Gallo
ns
(10
)G
ross
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
15
B/
B00
We H
aul It
All
We H
aul It
All
We H
aul It
All
65-9
8765
43
65-9
8765
43
65-9
8765
43
B S
FL FL
Test
Sup
plier
Test
Sup
plier
Test
49
Test
50
100
200
6
00
STTe
st S
uppl
ier
65-9
8765
43
65-9
8765
43
65-9
8765
43Te
st 51
03/01
/2017
03/02
/2017
03/03
/2017
300
FL
dr30
9636
tests
cript
Pg.
22
Test
Ope
rato
rT5
9FL2
116
6598
7654
303
/31/20
17
Test S
cript
Page 23
Pro
du
ct
Typ
e:
Sc
he
du
le o
f D
isb
urs
em
en
ts -
Te
rmin
al O
pe
rato
r
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B
00
Und
yed
/Unb
lend
ed
Bio
die
sel
(B100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
DR
-30
96
36
R.
01
/14
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Dest.
Sta
te
(5)
Term
inal
Sup
plie
r
(6)
Term
inal S
up
plie
r
FE
IN
(7)
Date
Sh
ipp
ed
(8)
Do
cu
men
t
Nu
mb
er
(9)
Net
Gallo
ns
(10
)G
ross
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
15
B/ 226
We H
aul It
All
We H
aul It
All
We H
aul It
All
65-9
8765
43
65-9
8765
43
65-9
8765
43
B S
FL FL
Test
Sup
plier
Test
Sup
plier
Test
52
Test
53
100
200
STTe
st S
uppl
ier
65-9
8765
43
65-9
8765
43
65-9
8765
43Te
st 54
03/01
/2017
03/02
/2017
03/03
/2017
300
FL
600
dr
3096
36 te
stscr
ipt P
g. 23
Test
Ope
rato
rT5
9FL2
116
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7654
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17
Test S
cript
Page 24
Pro
du
ct
Typ
e:
Sc
he
du
le o
f D
isb
urs
em
en
ts -
Te
rmin
al O
pe
rato
r
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B
00
Und
yed
/Unb
lend
ed
Bio
die
sel
(B100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
DR
-30
96
36
R.
01
/14
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Dest.
Sta
te
(5)
Term
inal
Sup
plie
r
(6)
Term
inal S
up
plie
r
FE
IN
(7)
Date
Sh
ipp
ed
(8)
Do
cu
men
t
Nu
mb
er
(9)
Net
Gallo
ns
(10
)G
ross
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
15
B/ 227
We H
aul It
All
We H
aul It
All
We H
aul It
All
65-9
8765
43
65-9
8765
43
65-9
8765
43
B S
FL FL
Test
Sup
plier
Test
Sup
plier
Test
55
Test
56
100
200
STTe
st S
uppl
ier
65-9
8765
43
65-9
8765
43
65-9
8765
43Te
st 57
03/01
/2017
03/02
/2017
03/03
/2017
300
FL
600
dr
3096
36 te
stscr
ipt P
g. 24
Test
Ope
rato
rT5
9FL2
116
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7654
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/31/20
17
Test S
cript
Page 25
Pro
du
ct
Typ
e:
Sc
he
du
le o
f D
isb
urs
em
en
ts -
Te
rmin
al O
pe
rato
r
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B
00
Und
yed
/Unb
lend
ed
Bio
die
sel
(B100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
DR
-30
96
36
R.
01
/14
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Dest.
Sta
te
(5)
Term
inal
Sup
plie
r
(6)
Term
inal S
up
plie
r
FE
IN
(7)
Date
Sh
ipp
ed
(8)
Do
cu
men
t
Nu
mb
er
(9)
Net
Gallo
ns
(10
)G
ross
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
15
B/ 072
We H
aul It
All
We H
aul It
All
We H
aul It
All
65-9
8765
43
65-9
8765
43
65-9
8765
43
B S
FL FL
Test
Sup
plier
Test
Sup
plier
Test
58
Test
59
100
200
STTe
st S
uppl
ier
65-9
8765
43
65-9
8765
43
65-9
8765
43Te
st 60
03/01
/2017
03/02
/2017
03/03
/2017
300
FL
600
dr
3096
36 te
stscr
ipt P
g. 25
Test
Ope
rato
rT5
9FL2
116
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7654
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/31/20
17
Test S
cript
Page 26
Pro
du
ct
Typ
e:
Sc
he
du
le o
f D
isb
urs
em
en
ts -
Te
rmin
al O
pe
rato
r
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B
00
Und
yed
/Unb
lend
ed
Bio
die
sel
(B100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
DR
-30
96
36
R.
01
/14
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Dest.
Sta
te
(5)
Term
inal
Sup
plie
r
(6)
Term
inal S
up
plie
r
FE
IN
(7)
Date
Sh
ipp
ed
(8)
Do
cu
men
t
Nu
mb
er
(9)
Net
Gallo
ns
(10
)G
ross
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
15
B/
D00
We H
aul It
All
We H
aul It
All
We H
aul It
All
65-9
8765
43
65-9
8765
43
65-9
8765
43
B S
FL FL
Test
Sup
plier
Test
Sup
plier
Test
61
Test
62
100
200
STTe
st S
uppl
ier
65-9
8765
43
65-9
8765
43
65-9
8765
43Te
st 63
03/01
/2017
03/02
/2017
03/03
/2017
300
FL
600
dr
3096
36 te
stscr
ipt P
g. 2
6
Test
Ope
rato
rT5
9FL2
116
6598
7654
303
/31/20
17
Test S
cript
Page 27
Pro
du
ct
Typ
e:
Sc
he
du
le o
f D
isb
urs
em
en
ts -
Te
rmin
al O
pe
rato
r
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B
00
Und
yed
/Unb
lend
ed
Bio
die
sel
(B100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
DR
-30
96
36
R.
01
/14
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Dest.
Sta
te
(5)
Term
inal
Sup
plie
r
(6)
Term
inal S
up
plie
r
FE
IN
(7)
Date
Sh
ipp
ed
(8)
Do
cu
men
t
Nu
mb
er
(9)
Net
Gallo
ns
(10
)G
ross
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
15
B/ 125
We H
aul It
All
We H
aul It
All
We H
aul It
All
65-9
8765
43
65-9
8765
43
65-9
8765
43
B S
FL FL
Test
Sup
plier
Test
Sup
plier
Test
64
Test
65
100
200
STTe
st S
uppl
ier
65-9
8765
43
65-9
8765
43
65-9
8765
43Te
st 66
03/01
/2017
03/02
/2017
03/03
/2017
300
FL
600
dr
3096
36 te
stscr
ipt P
g. 27
Test
Ope
rato
rT5
9FL2
116
6598
7654
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17
Test S
cript
Page 28
Pro
du
ct
Typ
e:
Sc
he
du
le o
f D
isb
urs
em
en
ts -
Te
rmin
al O
pe
rato
r
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B
00
Und
yed
/Unb
lend
ed
Bio
die
sel
(B100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
DR
-30
96
36
R.
01
/14
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Dest.
Sta
te
(5)
Term
inal
Sup
plie
r
(6)
Term
inal S
up
plie
r
FE
IN
(7)
Date
Sh
ipp
ed
(8)
Do
cu
men
t
Nu
mb
er
(9)
Net
Gallo
ns
(10
)G
ross
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
15
B/ 130
We H
aul It
All
We H
aul It
All
We H
aul It
All
65-9
8765
43
65-9
8765
43
65-9
8765
43
B S
FL FL
Test
Sup
plier
Test
Sup
plier
Test
67
Test
68
100
200
STTe
st S
uppl
ier
65-9
8765
43
65-9
8765
43
65-9
8765
43Te
st 69
03/01
/2017
03/02
/2017
03/03
/2017
300
FL
600
dr
3096
36 te
stscr
ipt P
g. 28
Test
Ope
rato
rT5
9FL2
116
6598
7654
303
/31/20
17
Test S
cript
Page 29
Pro
du
ct
Typ
e:
Sc
he
du
le o
f D
isb
urs
em
en
ts -
Te
rmin
al O
pe
rato
r
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
12
5
Avia
tio
n G
aso
line
13
0
Jet
Fuel
14
2
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B
00
Und
yed
/Unb
lend
ed
Bio
die
sel
(B100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
DR
-30
96
36
R.
01
/14
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s F
EIN
(3)
Mo
de
(4)
Dest.
Sta
te
(5)
Term
inal
Sup
plie
r
(6)
Term
inal S
up
plie
r
FE
IN
(7)
Date
Sh
ipp
ed
(8)
Do
cu
men
t
Nu
mb
er
(9)
Net
Gallo
ns
(10
)G
ross
Gal-
lons
Sub
tota
l
Sched
ule
/Pro
duct
Typ
eC
om
pany N
am
eIR
S T
erm
inal C
od
e N
um
ber
FE
INC
olle
ctio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
15
B/ 142
We H
aul It
All
We H
aul It
All
We H
aul It
All
65-9
8765
43
65-9
8765
43
65-9
8765
43
B S
FL FL
Test
Sup
plier
Test
Sup
plier
Test
70
Test
71
100
200
STTe
st S
uppl
ier
65-9
8765
43
65-9
8765
43
65-9
8765
43Te
st 72
03/01
/2017
03/02
/2017
03/03
/2017
300
FL
600
dr
3096
36 te
stscr
ipt P
g. 29
Test
Ope
rato
rT5
9FL2
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cript
