Form EIA-863 Petroluem Product Sales Identification Survey

U.S. DEPARTMENT OF ENERGY
U.S. Energy Information Administration
Washington, D.C. 20585

2010

OMB Number: XXXX-XXXX
Form Expires: XX/XX/XX
Version No.: XXXX.XX

EIA-863: PETROLEUM PRODUCT SALES IDENTIFICATION SURVEY

This report is mandatory under the Federal Energy Administration Act of 1974 (Public Law 93-275). Failure to comply may result in criminal fines, civil
penalties and other sanctions as provided by law. Title 18 USC 1001 makes it a criminal offense for any person knowingly and willingly to make to any
Agency or Department of the United States any false, fictitious, or fraudulent statements as to any matter within its jurisdiction. See Instructions for
further details on the sanctions.

PART 1. RESPONDENT IDENTIFICATION DATA

Begin here and follow numerical order
unless instructed otherwise.
Please provide corrections to company name, address,
contact information, and telephone number in items 1 thru 8.
1a. Company Name (only if different than the label)
1b. Is company name change a result of a previous sale,
merge, lease, or becoming a subsidiary since 2006?
Yes
 No
1c. Doing business as (If different than company name)
2. Name of Contact Person
3. Contact’s Telephone Number
-

-

4. Physical Address (eg. Street Address, Building, Floor, Suite)
5. Mailing Address (eg. PO Box, RR)

For assistance in completing this form call 1-800-382-0630
6. City

7. State

8. Zip Code

The information reported in items 1-8 of Part I, Respondent Identification Data, of the EIA-863 will be protected and not disclosed to the public to the extent that it
satisfies the criteria for exemption under the Freedom of Information Act (FOIA), 5 U.S.C. §552, the Department of Energy (DOE) regulations, 10 C.F.R. §1004.11,
implementing the FOIA, and the Trade Secrets Act, 18 U.S.C. §1905.
With regard to the information reported in items 1-8 of Part I, the Federal Energy Administration Act requires the EIA to provide company-specific data to other
Federal agencies when requested for official use. That information reported in Part I may also be made available, upon request, to another component of the DOE;
to any Committee of Congress, the Government Accountability Office, or other Federal agencies authorized by law to receive such information. A court of competent
jurisdiction may obtain this information in response to an order. That Part I information may be used for any non-statistical purposes such as administrative,
regulatory, law enforcement, or adjudicatory purposes.
The information reported in Part 1 item 9-18, Parts II, Preparer Information, and III, Total Sales Volumes by State, of the EIA-863 will be used for statistical purposes
only. In accordance with the Confidential Information Protection provisions of Title 5, Subtitle A, Public Law 107-347 and other applicable Federal laws, your
responses to Part I item 9-18, Parts II and III of Form EIA-863 will be kept confidential and will not be disclosed in identifiable form to anyone other than employees or
agents without your consent. By law, every EIA employee as well as every agent has taken an oath and is subject to a jail term, a fine of up to $250,000, or both if
he or she discloses such identifiable information about you.

9.

a.

Which of the following best describes your company’s operating status
at the end of 2010? (Check only 1 box)
 Your company is in operation—
sales include petroleum products.

b1.  Your company was sold, or
you merged with another
company.
b2.  You leased your company to
another company.
c.

d.

e.

f.

Your company has permanently
ceased operation.
Your company is a subsidiary of
another company and all or some
of your sales are reported by
another company.
Your company is a commissioned
agent for another company and all
or some of your sales are reported
by another company.
Your company does not sell any
petroleum products.

10. Enter the date your company sold, merged, leased, ceased
operation, became a subsidiary, or became a
commissioned agent:

Skip Items 10 thru 18.
Complete Parts II and III.
Complete items 10 thru
18. Also complete Part II
and Part III for the portion
of 2010 that you owned
and operated the
Company.
Complete item 10 (date
ceased) and Part II.

Month

Day

Year

11. Enter name of the company you sold to/merged with/leased
to/became a subsidiary of or commissioned agent for:

12. Enter name of the contact person of company in Item 11:

13. Contact’s Telephone Number
-

-

Complete items 10 thru 18
Also, complete Part II and
Part III for the portion of
2010 that you owned and
operated the company.

14. Physical Address (eg. Street Address, Building, Floor, Suite)

Complete Part II and return

16. City

(see instructions for “Where
to Submit”)

15. Mailing Address (eg. PO Box, RR)

17. State

18. Zip Code

EIA-863 (2010)

Page 2

Company Name

EIA ID Number

Reference Year

2010

Page______ of______

PART 2. PREPARER INFORMATION
19. Preparer’s Name

20a. Telephone Number

20b. Date

20c. E-mail Address

21. Fax Number

22. FOR EIA USE ONLY

Comments:

PART 3. TOTAL SALES VOLUMES (BY STATE) FOR 2010 (REPORT IN ACTUAL GALLONS)
23. Did your company sell No. 2 Distillate, No. 5 and No. 6 Residual Fuel Oil, Motor Gasoline, and/or Propane in 2010?
a.
Yes . . . . . Answer item 24
b.
No . . . . . Skip to item 25
24. Enter below in lines “a” through “p” your company’s total annual sales volumes in each State for the entire year of 2010
(report in actual gallons). Include all sales made by your divisions, branches, outlets, and subsidiaries. Report a sale in the
State where the transfer of ownership occurred
PLEASE NOTE: Enter the state you are reporting for in the blocks below using the 2 digit state abbreviation. If you have
sales in more than two states make a copy of Part III, record your other states and attach to the original form. State
abbreviations are listed on the last page of this form for your convenience.

PETROLEUM CATEGORY

No. 2 Distillate Fuel Oil and No. 2 Diesel–please
provide volumes for all that apply.
a.
b.
c.

Volumes

Volumes

(report in actual gallons)

(report in actual gallons)

No. 2 Residential Fuel Oil sold for heating private
homes (Include heating farm houses; Exclude apartments.)
No. 2 Fuel Oil for all other end uses (Include apartment
buildings; Exclude diesel fuel oil and gasoline.)

No. 2 Diesel Fuel for all other end uses (Include
agricultural use and on-highway use; Exclude gasoline.)

d.

No. 2 Fuel Oil sold to Dealers, Resellers, and Refiners
who will resell the product (Exclude gasoline.)

e.

No. 2 Diesel sold to Dealers, Resellers, and Refiners
who will resell the product (Exclude gasoline.)

f.

Total No. 2 Fuel Oil and
No. 2 Diesel sold in 2010.

(Add lines a thru e and
enter amount here)

No. 5 and No. 6 Residual Fuel OIL–please provide
volumes for all that apply.

Volumes

Volumes

(report in actual gallons)

(report in actual gallons)

No. 5 and No. 6 Fuel Oil sold to the Consumer
g.

(Examples: to electric utilities, to vessels for bunkering, to
industrial and commercial users, to military.)

h.

No. 5 and No. 6 Fuel Oil sold to Dealers, Resellers,
and Refiners who will resell the product.

i.

Total No. 5 and No. 6 Fuel Oil
sold in 2010.

(Add lines g thru h and
enter amount here)

Motor Gasoline and Gasohol – please provide
volumes for all that apply. (Report Gasohol and
Oxygenated Gasoline under Conventional, and include
OPRG under Reformulated.)
Motor Gasoline and Gasohol sold to the Consumer.
j.

k.

(Include all grades of gasoline; Exclude No. 2 diesel and
aviation gasoline.)

Motor Gasoline sold to Dealers, Resellers, and
Refiners who will resell the product. (Include rack and
DTW sales.)

l.

Total Motor Gasoline sold
in 2010.

(Add lines j thru k and
enter amount here)

Conventional
Gasoline

Reformulated
Gasoline

Conventional
Gasoline

Reformulated
Gasoline

(report in actual
gallons)

(report in actual
gallons)

(report in actual
gallons)

(report in actual
gallons)

EIA-863 (2010)

Page 3

Company Name

EIA ID Number

Reference Year

2010

Page ______of _______

PLEASE ENTER THE 2-LETTER STANDARD STATE ABBREVIATION

PETROLEUM CATEGORY

Propane – please provide volumes for all that apply.
m.

Volumes

Volumes

(report in actual gallons)

(report in actual gallons)

Delivered Residential Propane. (Home heating, including
farm houses.)

Propane sold to Customers for all other end uses.
n.
o.
p.
25.

(Include commercial, industrial, agricultural, and propane
powered motor vehicles.)

Propane sold to Dealers, Resellers, and Refiners who
will resell the product.
Total Propane sold in 2010.
(Add lines m thru o and
enter amount here)
Does your company sell any of these other petroleum products? Check boxes for all that you sell. (Other does not include No. 2 Fuel
Oil and No. 2 Diesel, No. 5 and No. 6 Residual Fuel Oil, Motor Gasoline, and Propane for which you have already reported volumes.)
a. Kerosene

b. No. 1 Distillate

e. 

f.

No. 4 Fuel Oil

Aviation Gasoline

c. Crude Oil

d. Other LPG

g. Jet Fuel

h. Other:______________________________
(Specify)

26.

Does your company sell and/or use propane for on-highway transportation use? Check appropriate box(es).
a.  Sell

27.

b. Use

c.  No

Does this firm currently sell (or has it ever sold) distillate fuel oil to railroad companies?
a.  Yes

b. No

Please submit this form to EIA by March 30, XXXX.
For submission by mail:

by fax:
by secure file transfer:

by email:

U.S. Energy Information Administration
U.S. Department of Energy
PO Box 659
College Park, MD 20741-0659
1-301-572-0998
https://signon.eia.doe.gov/upload/notice863.jsp
See Section 6 in the instructions for additional
information on how to file the EIA-863 electronically.
[email protected]

Page 4

LIST OF STANDARD STATE ABBREVIATIONS

AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS

... Alabama
... Alaska
... Arizona
... Arkansas
... California
... Colorado
... Connecticut
... Delaware
... District of Columbia
... Florida
... Georgia
... Hawaii
... Idaho
... Illinois
... Indiana
... Iowa
... Kansas

KY ... Kentucky
LA ... Louisiana
ME ... Maine
MD ... Maryland
MA ... Massachusetts
MI ... Michigan
MN ... Minnesota
MS ... Mississippi
MO ... Missouri
MT ... Montana
NE ... Nebraska
NV ... Nevada
NH ... New Hampshire
NJ ... New Jersey
NM ... New Mexico
NY ... New York
NC ... North Carolina

ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY

... North Dakota
... Ohio
... Oklahoma
... Oregon
... Pennsylvania
... Rhode Island
... South Carolina
... South Dakota
... Tennessee
... Texas
... Utah
... Vermont
... Virginia
... Washington
... West Virginia
... Wisconsin
... Wyoming