Unit:	Year:
Location:	Month:
SECTION 1 – Fuel Received
Date	Fuel Tank Reading	Gallons Gas	Gallons Diesel
Beginning Tank Reading
Date	Received From - Vendor	Gallons Gas	Gallons Diesel
Total Received
SECTION 2 – Fuel Issued
Date	Issued To – Driver Name	Pool No.	License No.	Cost Code	Gallons Gas	Gallons Diesel
Total Issued
SECTION 3 – Balance
Date	Fuel Tank Reading	Gallons Gas	Gallons Diesel
Ending Tank Reading
Balance (Beginning Tank Reading + Total Received – Total Issued)
Balance should equal the Ending Tank Reading