Page 101 - IRS Business Tax Credits Guide
P. 101
12:51 - 5-Jan-2023
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Fileid: … ns/i8933/202212/a/xml/cycle06/source
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
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Disposal Operator Certification (continued)
10 Complete Table 3 below using information that’s consistent with all applicable EPA filings. If there are more than four owners of the geologic
disposal site or suppliers of qualified carbon oxide, prepare a separate table with all the supplier information and attach it to this model
certificate.
11 Check here to attest that all figures in Table 3 conform to all applicable EPA filings . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Table 3 — Information About Disposal
Qualified carbon Qualified carbon Qualified carbon Total qualified All other suppliers Total metric tons for all
oxide supplier oxide supplier oxide supplier carbon oxide from of nonqualified carbon oxide suppliers
number 1 number 2 number 3 all suppliers carbon oxide
(H)
Metric (I) Metric (L) Metric
(C) tons (M) Metric
(A) (B) (D) (E) (F) (G) tons (J) (K) tons
Geologic Metric Metric Metric Metric Metric Metric delivered stored Metric Metric delivered tons stored
(add
(add
tons
disposal tons tons tons tons tons (add tons tons (add
site owner delivered store delivered stored delivered stored columns columns delivered stored columns columns (I)
d (C), (E), and (K))
(B), (D), and (G)) (H) and (J))
and (F))
1
2
3
4
5 Total
(add lines
1 through
4)
Under penalties of perjury, I attest that I am an officer of the company that’s the operator of the subject geologic disposal site or that I have been
designated by the operating interest owners to prepare and submit this certificate to the IRS on their behalf. I further attest that the above information
is true and correct.
Signature and date signed
Printed or typed name of person signing this report
Title
Company’s name and EIN
Model Certificate DISP‐Operator
-22- Instructions for Form 8933 (Rev. 12-2022)