Form BOE-501-IR Fillable California Oil Spill Response Annual Information Return

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(6 TOTAL BARRELS (add lines 1 through 5) TOTAL ) (BARRELS CRUDE OIL 1 Crude oil received at a refinery within this state ) (BARRELS CRUDE OIL 4 Crude oil transported from a marine terminal by means of marine vessel to a destination outside this state ) (BARRELS CRUDE OIL 5 Crude oil transported by a pipeline operator to a destination outside this state ) (BARRELS CRUDE OIL 6 TOTAL BARRELS (add lines 1 through 5) ) (BARRELS PETROLEUM PRODUCTS 2 Petroleum products received at a marine terminal by vessel from a point of origin outside this state ) (BARRELS PETROLEUM PRODUCTS 3 Petroleum products transported into the state by means of a pipeline over through or under marine waters ) (BARRELS PETROLEUM PRODUCTS 6 TOTAL BARRELS (add lines 1 through 5) ) (BOE USE ONLY) (CLEAR) CLEAR (DATE) (DUE ON OR BEFORE) (EMAIL ADDRESS) (PRINT NAME AND TITLE) (PRINT) PRINT (TELEPHONE (AREA CODE)) (TELEPHONE) (text) (text) (TOTAL ) (TOTAL ) (YOUR ACCOUNT NO ) [ FOID] 1 800 400 7115 (TTY:711); from the main menu select the option Special Taxes and Fees 2 Petroleum products received at a marine terminal by 6 TOTAL BARRELS (add lines 1 through 5) above The return must be filed even if you have no barrels to report during this reporting period No fee is due with Barges means any vessel that carries oil in commercial quantities as cargo but is not equipped with a means of barrels of petroleum products received at a marine terminal within this state by means of vessel arriving from a point BARRELSCRUDE OILPETROLEUM PRODUCTSTOTAL1 Crude oil received at a refinery within this state BOARD OF EQUALIZATIONSPECIAL TAXES AND FEESPO BOX 942879SACRAMENTO CA 94279 0030 BOE 501 IR (BACK) REV 4 (4 13) BOE 501 IR (FRONT) REV 4 (4 13) bunker fuel and alcohol fuels containing petroleum products by means of a vessel from a point of origin outside this state CALIFORNIA OIL SPILL RESPONSE FEE ANNUAL INFORMATION RETURN commercial quantities as cargo Crude Oil means petroleum in an unrefined or natural state including condensate and natural gasoline crude oil received at a refinery within this state Crude oil transported by a pipeline operator to a Crudeoiltransportedfromamarineterminalbymeansof marine vessel to a destination outside this state DEFINITIONS Delta upstream from a line running north and south through the point where Contra Costa Sacramento and destination outside this state DUE ON OR BEFORE EMAIL ADDRESS exploring for drilling for producing storing handling transferring processing refining or transporting oil and is filing of annual information returns FILING REQUIREMENTS For All Lines Enter Total Number of Barrels for Reporting Period GENERAL INFORMATION I hereby certify that this return including any accompanying schedules and statements has beenexamined by me and to the best of my knowledge and belief is a true correct and complete return If you need additional information please contact the State Board of Equalization Special Taxes and Fees P O Box 942879 INSTRUCTIONS FOR PREPARING THE CALIFORNIAOIL SPILL RESPONSE FEE ANNUAL INFORMATION RETURN Keene Seastrand Oil Spill Prevention and Response Act Revenue and Taxation Code section 46151 (c) requires the Line 1 Enter the total number of barrels of crude oil received at a refinery located in this state Line 2 Enter the total number of barrels of petroleum products received at a marine terminal within this state Line 3 Enter the total number of barrels of petroleum products transported into the state by means of a Line 4 Enter the total number of barrels of crude oil transported from a marine terminal by means of a marine Line 5 Enter the total number of barrels of crude oil transported by a pipeline operator to 44 destination Line 6 Enter the total number of barrels reported on lines 1 through 5 located in marine waters or is located where a discharge could impact marine waters Marine Facility means any facility of any kind other than a vessel which is or was used for the purposes of Marine Terminal means any marine facility used for transferring oil to or from tankers or barges For the purposes Marine Terminal Operators You are required to complete and file this form to report to the BOE: (1) the number of Marine Waters means those waters subject to tidal influence except for waters in the Sacramento San Joaquin marine waters of this state; and (2) the number of barrels of crude oil transported out of the state by pipeline may be refined as a fuel or fuel blendstock including but not limited to gasoline diesel fuel aviation fuel means of marine vessel or barge to a destination outside this state Note: This annual return covers a one year calendar period and must be filed on or before the due date shown of a pipeline over through or under marine waters of origin outside this state; and (2) the number of barrels of crude oil that are transported from within this state by of petroleum products transported into the state by means of pipelines operating across under or through the of the fractionation distillation or other refining or processing of crude oil and that is used as useable as or of this section a marine terminal includes all piping not integrally connected to a tank facility as defined in outside this state Payments: You can make your payment by paper check Online ACH Debit (ePay) or by credit card To use ePay go to our Petroleum Product means any liquid hydrocarbon at atmospheric temperature and pressure that is the product Petroleum products transported into the state by means Pipeline means any pipeline used at any time to transport oil Pipeline Operators You are required to complete and file this form to report to the BOE: (1) the number of barrels pipeline over through or under marine waters PREPARATION OR RETURN PRINT NAME AND TITLE READ INSTRUCTIONSBEFORE PREPARINGMake changes if nameor address is incorrect Refinery Operators You are required to complete and file this form to report to the BOE the number of barrels of Sacramento CA 94279 0088 You may also visit the BOE website at www boe ca gov or call the Taxpayer Information Section at self propulsion SIGNATURE Solano Counties meet STATE OF CALIFORNIABOARD OF EQUALIZATION subdivision (k) of section 25270 2 of the Health and Safety Code Tanker means any self propelled waterborne vessel constructed or adapted for the carriage of oil in bulk or in TELEPHONE( The State Board of Equalization (BOE) is responsible for collecting fees and information under the Lempert this return This return must be signed Make a copy of this document for your records vessel from a point of origin outside this state Vessel means a tanker or barge as defined above vessel to a destination outside this state website at www boe ca gov click on the eServices tab and log in to make a payment To pay by credit card go to our website or call 1 855 292 8931 Mandatory EFT accounts must pay by EFT or ePay Be sure to sign and mail your return YOUR ACCOUNT NO

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