F acility MVNR L M Dies el F uel R eport Ins tructions

OMB C ontrol No. 2060

- 0308 E xpires 12/31/2011


### Des ignate & T rac k Handoff R eport Is s ue Date: 09/15/2006 R eport F orm ID: DS F 0504 R evis ed: 04/ 1 5/2011

Page 1 Handoff reports must be submitted separately by each facility in the Designate & Track (D&T) system where designated distillate is delivered to and/or received from another facility, separately by trading partner and separately by Tax/Dye/Marker status. This form has quarterly and annual reporting requirements. Each quarter, provide the volume totals of the transactions completed during the quarter. Annually, provide the volume totals of the entire compliance year. In the fourth quarter, both a quarter ly (4 th quarter) and an annual report must be submitted.

NOTE: Truck Loading Terminals, including multi

- use facilities, that, in addition to a truck rack, have refining and/or pass

- through activities, must submit this report for all designated distillates received. Volume of taxed or dyed/marked, designated, distillates delivered over the truck rack (leaving D&T) are not reported on this form and are covered by the Designate & Track Total Volume Report (DSF0600). All

other volumes of un

- taxed/un

- dyed/un

- marked distillates leaving multi

- use facilities and continuing on in D&T must be reported as deliveries.

Reports using this form must be submitted quarterly with due dates of November 30 th , February 28 th , May

31 st , and August 31 st

. Please check the Diesel Fuel Reporting Forms web site for updated instructions and report form templates: http://epa.gov/otaq/regs/fuels/dieselfms.htm

For information on submitting this report using EPA’s Central Data Exchange (CDX) visit: http://epa.gov/otaq/regs/fuels/cdxinfo.htm

Field

No. Field Name Units F ield F ormats , C odes , & S pecial Ins tructions

1. Report Form ID AAAAAAA ; C haracter . Enter the DS F050 4 for this Designate & Track Handoff Report

2. Report Type A ; C haracter . Submit only one original report, submit any corrections or updates as resubmission(s):

O : Original

R : Resubmission

3. CBI A ; C haracter . Specify if the data contained within the report is claimed as Confidential Business Information (CBI) under 40 CFR Part 2, subpart B:

Y : Confidential Business Information

N : Non

- Confidential Business Information

4. Report Date MM/DD/Y Y Y Y ; C haracter . Enter the date you create this report. If resubmitting, use the current date and not the date on the original report.

5. Report Year YYYY ; C haracter . The report year is determined by the annual compliance period. If an annual compliance period spans two years, enter the second year (e.g. for the compliance year June 1, 2006 through May 31, 2007 use 2007).

6. Company/Entity ID AAAA ; C haracter . Enter the four

- digit, EPA

- assigned ID for the company/entity (refiner, importer, etc.).F acility MVNR L M Dies el F uel R eport Ins tructions

OMB C ontrol No. 2060

- 0308 E xpires 12/31/2011


### Des ignate & T rac k Handoff R eport Is s ue Date: 09/15/2006 R eport F orm ID: DS F 0504 R evis ed: 04/ 1 5/2011

Page 2 Field

No. Field Name Units F ield F ormats , C odes , & S pecial Ins tructions

7. Facility ID AAAAA ; C haracter . Enter the five

- digit, EPA

- assigned ID for the facility. Please include any preceding zeros.

8. Compliance Period

Code A A ; C haracter . Compliance Period Codes. General month ranges are provided below to assist in labeling quarters. See the list of specific compl iance periods in 40 CFR

80.599 :
Quarterly
Q1 : First Quarter (July – September)

Q2 : Second Quarter (October – December)

Q3 : Third Quarter (January – March)

Q4 : Fourth Quarter (April – June)

Annual T otal

A1 : Annual Handoff Totals

9. Handoff Type A A ; C haracter . Separately report deliveries and receipts. Specify whether this summary is for product delivered to or product received from the identified partner.

T X : Delivered To Partner

R X : Received From Partner

10. Partner Entity ID AAAA ; C haracter . Enter the four

- digit, EPA

- assigned ID for your trading partner. For receipt of distillate from an entity that does not have an ID per 80.601(a)(3) use “8888”.

11. Partner Facility ID AAAAA ; C haracter . Enter the five

- digit, EPA

- assigned ID for your trading partner’s facility. Please include preceding zeros if applicable. For receipt of distillate from a facility that does not have an ID per 80.601(a)(3) use “88888”.

12. Tax/Dye/Marker

Status AAA ; C haracter. Separately report Taxed/Dyed and Untaxed Clear distillates. Specify if the product delivered was either taxed, dyed or marked (e.g. product leaving a truck rack) or untaxed and clear (product entering D&T).

TDM : Taxed/Dyed/Marked (non

- D&T fuel or fuel l eaving D&T)

FUN : Untaxed/Clear (fuel entering D&T or continuing on in D&T)

13. 500 ppm NRLM gallons 999999999 ; Number. Total volume of 500 ppm NRLM delivered/received for the period. If this product type was not received or delivered, enter “0”.F acility MVNR L M Dies el F uel R eport Ins tructions

OMB C ontrol No. 2060

- 0308 E xpires 12/31/2011


### Des ignate & T rac k Handoff R eport Is s ue Date: 09/15/2006 R eport F orm ID: DS F 0504 R evis ed: 04/ 1 5/2011

Page 3 Field

No. Field Name Units F ield F ormats , C odes , & S pecial Ins tructions

14. 500 ppm NR gallons 999999999 ; Number. Total volume of 500 ppm NR delivered/received for the period. If this product type was not received or delivered, enter “0”.

15. 500 ppm LM (Marked) gallons 999999999 ; Number. Total volume of 500 ppm LM delivered/received for the period. The Tax/Dye/Marker Status field should indicate TDM. If this product type was not received or delivered, enter “0”.

16. 500 ppm LM (Un

marked) gallons 999999999 ; Number. Total volume of 500 ppm LM

delivered/receiv ed for the period. This product will have no marker and the Tax/Dye/Marker Status Field should indicate FUN. If this product type was not received or delivered,

enter “0”.

17. High Sulfur NRLM gallons 999999999 ; Number. Total volume of High Sulfur NRLM delivered/received for the period. If this product type was not received or delivered, enter “0”.

18. Heating Oil (Marked) gallons 999999999 ; Number. Total volume of Marked Heating Oil delivered/received for the period. This product typically will

onl y be leaving D&T and requires both a dye and marker outside the NEMA (see 40 CFR 80.510). The Tax/Dye/Marker Status field should indicate TDM. If this product type was not received or delivered, enter “0”.

19. Heating Oil (Un

marked) gallons 999999999 ; Number. Total volume of Un

- marked Heating Oil delivered/received for the period. This product will have no marker and the Tax/Dye/Marker Status Field should indicate FUN. If this product type was not received or delivered, enter “0”.

Electronic Submission Sample Record:

DSF050 4 ,O,Y,02/21/201 1 ,201 1 ,1234,12345,Q3,TX,4321,54321,FUN,0,2000,0,0,0,0,0F acility MVNR L M Dies el F uel R eport Ins tructions

OMB C ontrol No. 2060

- 0308 E xpires 12/31/2011


### Des ignate & T rac k Handoff R eport Is s ue Date: 09/15/2006 R eport F orm ID: DS F 0504 R evis ed: 04/ 1 5/2011

Page 4 Paperwork Reduction Act Statement

The public reporting and recordkeeping burden for this collection of information is disclosed in the estimates of the individual report form instructions. Burden means the total time, effort, or financial resources expended by persons to generate, maintain, retain, or disclose or provide information to or for a Federal agency. This includes the time needed to review instructions; develop, acquire, install, and utilize technology and systems for the purposes of collecting, validating, and verifying information, processing and maintaining information, and disclosing and providing information; adjust the existing ways to comply with any previously applicable instructions and requirements; train personnel to be able to respond to a collection of information; search data sources; complete and review the collection of information; and transmit or otherwise disclose the information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid

OMB control number.

Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822), 1200 Pennsylvania Ave. , NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.