Form BOE-501-OA Fillable California Oil Spill Prevention and Administration Fee Return

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(1 Crude oil received at a marine terminal from within or outside the state BARRELS CRUDE OIL ) (2 Crude oil originating from a production facility in marine waters and transported in the state by means of a pipeline operating across under or through marine waters BARRELS CRUDE OIL ) (3 Petroleum products received at a marine terminal from outside this state BARRELS PETROLEUM PRODUCTS ) (4 Total barrels (add lines 1 through 3) BARRELS CRUDE OIL ) (5 Rate of fee per barrel TOTAL $) (6 Total amount of fee due (multiply line 4 by line 5) TOTAL $) (7 PENALTY [multiply line 6 by 10% (0 10) if payment made or return filed after due date shown above] TOTAL $) (8 INTEREST: One month's interest is due on tax for each month or fraction of a month that payment is delayed after the due date The adjusted monthly interest rate is ) (9 TOTAL AMOUNT DUE AND PAYABLE (add lines 6 7 and 8) TOTAL $) (BARRELS PETROLEUM PRODUCTS ) (BARRELS TOTAL ) (BARRELS TOTAL ) (BOE USE ONLY ) (CLEAR) CLEAR (DATE) (DUE ON OR BEFORE) (EMAIL ADDRESS) (INTEREST TOTAL $) (PRINT NAME AND TITLE) (PRINT) PRINT (TELEPHONE (AREA CODE)) (TELEPHONE) (text) (text) (YOUR ACCOUNT NO ) [ FOID] 2 Crude oil originating from a production facility in marinewaters and transported in the state by means of a pipelineoperating across under or through marine waters 3 Petroleum products received at a marine terminalfrom outside this state 4 Total barrels (add lines 1 through 3) 5 Rate of fee per barrel$ 6 Total amount of fee due (multiply line 4 by line 5)$ 7 Penalty [multiply line 6 by 10% (0 10) if payment made or return filed after due date shown above]PENALTY$ 8 INTEREST: One month's interest is due on tax for each month or fraction of a month that payment is delayedafter the due date The adjusted monthly interest rate is 9 TOTAL AMOUNT DUE AND PAYABLE (add lines 6 7 and 8)$ 94279 0088 You may also visit the BOE website at www boe ca gov or call the Taxpayer Information Section at 1 800 400 7115 (TTY:711); from a blend of alcohol and petroleum Always write your account number on your check or money order Make a copy of this document for your records amount of the fee if any due for that period This return must be filed even though no fees are due any liquid hydrocarbon at atmospheric temperature and pressure that is the product of the fractionation BARRELSCRUDE OILPETROLEUMPRODUCTSTOTAL1 Crude oil received at a marine terminal from within oroutside the state BOARD OF EQUALIZATIONSPECIAL TAXES AND FEESPO BOX 942879SACRAMENTO CA 94279 6147 BOE 501 OA (BACK) REV 7 (4 13) BOE 501 OA (FRONT) REV 7 (4 13) CALIFORNIA OIL SPILL PREVENTION AND ADMINISTRATION FEE RETURN Crude oil means for purposes of the oil spill prevention and administration fee under section 8670 40 any DATEEMAIL ADDRESS DEFINITIONS Delta upstream from a line running north and south through the point where Contra Costa Sacramento and distillation or other refining or processing of crude oil and is used as useable as or may be refined as a fuel or DUE ON OR BEFORE Every marine terminal operator shall pay a fee for each barrel of crude oil received at the operator's marine terminal from within exploring for drilling for producing storing handling transferring processing refining or transporting oil and is fee due should be shown on line 7 FILING REQUIREMENTS fuel blendstock including but not limited to gasoline diesel fuel aviation fuel bunker fuel and fuels containing 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 Sacramento CA If your fee is paid after the due date shown on the front of this return a penalty of 10 percent (0 10) of the total including condensate and natural gasoline INSTRUCTIONS Line 1 Enter the total number of barrels of crude oil received at a marine terminal from within or outside the Line 2 Enter the total number of barrels of crude oil originating from a production facility in marine waters andtransported in the state by means of pipeline operating across under or through marine waters Line 3 Enter the total number of barrels of petroleum products received at a marine terminal from outside thisstate Line 4 Enter total barrels reported on lines 1 through 3 Line 5 Rate of fee per barrel Current rate of fee per barrel Line 6 Enter the tax computed by multiplying the number of barrels on line 4 by the rate shown on line 5 Line 9 Enter the total amount due and payable including late filing charges if applicable located in marine waters or is located where a discharge could impact marine waters main menu select the option Special Taxes and Fees Make check or money order payable to State Board of Equalization 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 waters means those waters subject to tidal influence except for waters in the Sacramento San Joaquin means of pipeline operating across under or through the marine waters of this state naturally occurring liquid hydrocarbon at atmospheric temperature and pressure coming from the earth of this section a marine terminal includes all piping not integrally connected to a tank facility as defined in or outside the state and for every barrel of petroleum products received from outside the state Every operator of a pipeline Payments: You can make your payment by paper check Online ACH Debit (ePay) or by credit card To use ePay go to our PENALTY FOR LATE FILING Petroleum product means for purposes of the oil spill prevention and administration fee under section 8670 40 Pipeline means any pipeline used at any time to transport oil PREPARATION OF RETURN Prevention and Response Act PRINT NAME AND TITLE READ INSTRUCTIONSBEFORE PREPARINGMake changes if nameor address is incorrect shall pay a fee for each barrel of crude oil originating from a production facility in marine waters and transported in the state by SIGNATURE Solano Counties meet state during this period STATE OF CALIFORNIABOARD OF EQUALIZATION subdivision (k) of section 25270 2 of the Health and Safety Code TELEPHONE( The return shall be filed on or before the 25th day of the month following the reporting period together with a remittance for the The State Board of Equalization is responsible for collecting the fees payable under the Lempert Keene Seastrand Oil Spill 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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