720-TO                                                                                                     OMB No. 1545-1734
 Form                                           Terminal Operator Report                                          
(Rev. September   2010)
Department of the Treasury                       
Internal Revenue Service                         For the month ending              , 20.                          Corrected     Void
                                                                                                                                 
 Part I       Terminal Operator
               
Company name                                                                             Employer identification number (EIN)

 Address (number, street, room or suite number)                                           Form 637 registration number

 City, state, and ZIP code

Contact person                     Daytime     telephone number Fax number                 Email address
                                   (           )                (              )
                                                                                
 Part II      Terminal
               
 Name of terminal                                                                          Terminal control number (TCN)

 Terminal location

 Part III     Transactions for the Month
               
                                                 Net Gallons (attach additional schedule(s) if needed)
                                                                
                                                 Enter the transactions for the period on Schedules A and B, then complete lines
                                                 1 through 7 for each product code (PC) (see the instructions).
                                                  
                                                         (a)                    (b)               (c)                        (d)
                                                 PC:                         PC:          PC:                     PC:         
                                                                                                                   
 1    Beginning inventory.
       
 2    Total receipts. Enter the total net
      gallons from Schedule(s) A, column
      (g), by PC.
       
 3    Total gallons available. Add lines 1
      and 2.
 4    Total disbursements.   Enter the
      total net gallons from Schedule(s) B,
      column (f). If you have
      disbursements for more than one
      position holder for a PC, add the
      amounts from each position holder’s
      Schedule B and enter the combined
      total by PC.
       
 5    Subtract line 4 from line 3.
       
 6    Stock gains and losses. Show
      losses in (parentheses).
 7      Actual physical ending inventory at
      terminal.
       
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete.
 
Signature�                                               Title, if applicable �                         Date          �
                                                                                                                       
Type or print your name below signature.
 
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.      Cat. No. 73072W Form 720-TO (Rev. 9-2010)

 Form 720-TO (Rev. 9-2010)                                                                                                    Corrected     Void                   Page 2  
Terminal operator name as shown on Form 720-TO                        EIN             TCN                                   For the month ending (enter MM/DD/YYYY)

 Schedule A            Terminal Operator Receipts
                        
                                                                                    Page                       of
 1 Product Code (PC).     Enter the PC (see instructions). A separate                 For more than one Schedule  A, for each different PC, number each sheet. For
   schedule is required for each PC                                   �             example, 1 of 4, 2 of 4, etc.
 1aPosition Holder (PH) name. Enter PH name for PCs Bxx, Dxx,               PH EIN   PH Form 637 registration number
   and Exx. Enter one name per page.                                                 
    
 2 Enter in the columns below the information requested for the PC on line 1 above.
                   (a)                        (b)                        (c)          (d)                      (e)                  (f)                  (g)
                  Carrier                     Carrier                 Mode         Vessel official number     Document        Document                   Net
                  name                        EIN                      code        (required when mode code isdate              number                  gallons
                                                                                   B, S, IB, IS, EB, or ES)                                              
                                                                                    
 3 Total. Add amounts in column (g) and enter the total. If there is more than one page for a PC, add the amounts from each page
   and enter the result on the last page of Schedule A for that PC. Do not enter page subtotals. Enter the amount from column (g) on
   Form 720-TO, Part III, line 2, in the column for the applicable PC                                                                       �
                                                                                                                                                 3
                                                                                                                                                  
                                                                                                                                            Form 720-TO (Rev. 9-2010)
                                                                                                                                                          

 Form 720-TO (Rev. 9-2010)                                                                                                                        Corrected     Void                    Page 3  
Terminal operator name as shown on Form 720-TO                            EIN                           TCN                                      For the month ending (enter MM/DD/YYYY)

 Schedule B       Terminal Operator Disbursements by Position Holder
                   
  Position Holder name. Enter one name per page.                                PH EIN            PH Form 637 registration number   Page                       of
                                                                                                                                    For more than one Schedule B, for each different PC, DS, or
                                                                                                                                    MC, number each sheet. For example, 1 of 4, 2 of 4, etc.
                                                                                                                                     
    Complete lines 1 through 4 for each PC.
 1  Product       Code (PC). Enter the PC (see instructions). A separate schedule is required for each PC                                                             �      1
   2                                                                                                                                                                          
    Destination State (DS). Enter the DS for each PC (see instructions). A separate schedule is required for each PC by state. PC 167 destined for Virginia
    (VA) and Maryland (MD) requires two schedules                                                                                                                     �      2
                                                                                                                                                                       
 3  Mode Code (MC). Enter the MC (see instructions) for each PC for each DS. PC 167 destined for VA by truck and rail and destined for MD by truck and                        
    rail would require four separate schedules: (1) PC 167, VA, rail; (2) PC 167, VA, truck; (3) PC 167, MD, rail; and (4) PC 167, MD, truck                          �      3
                                                                                                                                                                              
    Example. ABC Terminal is preparing Schedule B for disbursements made by position holder XYZ. XYZ disburses gasoline (PC 065), diesel fuel #2 low sulphur undyed
    (PC 167), and jet fuel (PC 130) during the month destined for two states by truck. ABC must prepare six Schedules B to report XYZ’s transactions (3 PCs x 2 DSs). A
    further breakdown by MC is not needed because only truck was used.
 4   Enter in the columns below the information requested for the PC on line 1 above.
                   (a)                          (b)                          (c)                        (d)                      (e)                     (f)                   (g)
                  Carrier                       Carrier         Vessel official number            Document  Document                                  Net                      Gross
                  name                          EIN             (required when mode code is            date number                                   gallons                  gallons
                                                                B, S, IB, IS, EB, or ES)                                                                                       
                                                                 
 5  Totals. Add all amounts in columns (f) and (g) for each PC, DS, or MC. If there are two MCs for a product destined for one
    state, or if a product is destined for two states, then two Schedules B and totals are required. If there is more than one Schedule
    B for a PC, DS, or MC, add the amounts from each schedule and enter the result on the last page of Schedule B for each
    different PC, DS, or MC. Do not enter page subtotals. Enter the amount from column (f) for each PC on Form 720-TO, Part III,
    line 4, in the column for the applicable PC                                                                                         �    5(f)                      5(g)
                                                                                                                                         
                                                                                                                                                                Form  720-TO (Rev. 9-2010)