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Form BOE-501-FGP Fillable Hazardous Waste Generator Fee Prepayment Form - Federal
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)00 NEAREST (0 10) penalty (1 Amount of prepayment (enter amount from worksheet on reverse) $) (2 Penalty [multiply line 1 by 10% (0 10) if payment is made after due date shown above] $ ) (4 TOTAL AMOUNT DUE AND PAYABLE (add lines 1 and 2) $ ) (9 TOTAL AMOUNT DUE (add lines 1 through 8 in column D; enter here and on line 1 on front page) $) (A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 1 Generators which generate less than 5 tons per site C AMOUNT OF FEES $) (A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 1 Generators which generate less than 5 tons per site D Total Fee Due (Column B x C) $) (A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 2 Generators which generate an amount equal to or more than 5 tons but less than 25 tons per site C AMOUNT OF FEES $) (A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 2 Generators which generate an amount equal to or more than 5 tons but less than 25 tons per site D Total Fee Due (Column B x C)) (A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 3 Generators which generate an amount equal to or more than 25 tons but less than 50 tons per site C AMOUNT OF FEES $) (A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 3 Generators which generate an amount equal to or more than 25 tons but less than 50 tons per site D Total Fee Due (Column B x C)) (A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 4 Generators which generate an amount equal to or more than 50 tons but less than 250 tons per site C AMOUNT OF FEES $) (A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 4 Generators which generate an amount equal to or more than 50 tons but less than 250 tons per site D Total Fee Due (Column B x C)) (A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 5 Generators which generate an amount equal to or more than 250 tons but less than 500 tons per site C AMOUNT OF FEES $) (A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 5 Generators which generate an amount equal to or more than 250 tons but less than 500 tons per site D Total Fee Due (Column B x C)) (A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 6 Generators which generate an amount equal to or more than 500 tons but less than 1 000 tons per site C AMOUNT OF FEES $) (A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 6 Generators which generate an amount equal to or more than 500 tons but less than 1 000 tons per site D Total Fee Due (Column B x C)) (A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 7 Generators which generate an amount equal to or more than 1 000 tons but less than 2 000 tons per site C AMOUNT OF FEES $) (A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 7 Generators which generate an amount equal to or more than 1 000 tons but less than 2 000 tons per site D Total Fee Due (Column B x C)) (A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 8 Generators which generate an amount equal to or more than 2 000 tons per site C AMOUNT OF FEES $) (A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 8 Generators which generate an amount equal to or more than 2 000 tons per site D Total Fee Due (Column B x C)) (BOE USE ONLY ) (CLEAR) CLEAR (Column B x C) (DATE) (Do not (DUE ON OR BEFORE) (EMAIL ADDRESS) (for example recycling or disposal) (OPTION 1 WORKSHEET A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 5 Generators which generate an amount equal to or more than 250 tons but less than 500 tons per site B NUMBER OF SITES (Do not list tonnage)) (OPTION 1 WORKSHEET A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 7 Generators which generate an amount equal to or more than 1 000 tons but less than 2 000 tons per site B NUMBER OF SITES (Do not list tonnage)) (OPTION 1 WORKSHEET Please select the appropriate fee category for each site that generated hazardous waste in this state A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 1 Generators which generate less than 5 tons per site B NUMBER OF SITES (Do not list tonnage)) (OPTION 1 WORKSHEET Please select the appropriate fee category for each site that generated hazardous waste in this state A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 2 Generators which generate an amount equal to or more than 5 tons but less than 25 tons per site B NUMBER OF SITES (Do not list tonnage)) (OPTION 1 WORKSHEET Please select the appropriate fee category for each site that generated hazardous waste in this state A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 3 Generators which generate an amount equal to or more than 25 tons but less than 50 tons per site B NUMBER OF SITES (Do not list tonnage)) (OPTION 1 WORKSHEET Please select the appropriate fee category for each site that generated hazardous waste in this state A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 4 Generators which generate an amount equal to or more than 50 tons but less than 250 tons per site B NUMBER OF SITES (Do not list tonnage)) (OPTION 1 WORKSHEET Please select the appropriate fee category for each site that generated hazardous waste in this state A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 6 Generators which generate an amount equal to or more than 500 tons but less than 1 000 tons per site B NUMBER OF SITES (Do not list tonnage)) (OPTION 1 WORKSHEET Please select the appropriate fee category for each site that generated hazardous waste in this state A CLASSIFICATION OF GENERATING SITES (Total volume of hazardous waste generated at each site during January 1 through June 30 of the current calendar year) 8 Generators which generate an amount equal to or more than 2 000 tons per site B NUMBER OF SITES (Do not list tonnage)) (OR OPTION 2 WORKSHEET A Enter amount of fee due to the BOE for the entire prior year as reported on line 10 of the Federal Hazardous Waste Generator Fee annual return This amount is exclusive of any prepayments or penalties (if zero for the prior period you must use Option 1) $) (OR OPTION 2 WORKSHEET B Multiply amount on line A by 50% (line A x 0 50) enter the result here and on line 1 on front page) $) (PRINT NAME AND TITLE) (PRINT) PRINT (TELEPHONE (AREA CODE)) (TELEPHONE) (text) (text) (text) (Total volume of hazardous waste generated at each site during (YOUR ACCOUNT NO ) [ FOID ] 1 000 tons but less than 2 000 tons per site 1 Amount of prepayment (enter amount from worksheet on reverse) 1 $ 1 Generators which generate less than 5 tons per site 1) Used motor oil removed from motor vehicles that is recycled by a recycler permitted by the Department of Toxic Substances 2 000 tons per site 2 Generators which generate an amount equal to or more than 2 Penalty [multiply line 1 by 10% (0 10) if payment is made 2) Waste that is generated recycled and reused onsite and is not transferred offsite at any time 25 tons but less than 50 tons per site 250 tons but less than 500 tons per site 3 Generators which generate an amount equal to or more than 3 Interest does not apply to this program 3 3) Aqueous waste treated onsite in a treatment unit operating or which subsequently operates under a permit by regulation 4 Generators which generate an amount equal to or more than 4 TOTAL AMOUNT DUE AND PAYABLE (add lines 1 and 2) 4 $ 5 Generators which generate an amount equal to or more than 5 tons but less than 25 tons per site 50 tons but less than 250 tons per site 500 tons but less than 1 000 tons per site 6 Generators which generate an amount equal to or more than 7 Generators which generate an amount equal to or more than 8 Generators which generate an amount equal to or more than 9 TOTAL AMOUNT DUE (add lines 1 through 8 in column D; enter here and on line 1 on 94279 0088 You may also visit the BOE website at www boe ca gov or call the Taxpayer Information Section at 1 800 400 7115 (TTY:711); A Enter amount of fee due to the BOE for the entire prior year as reported on line 10 of the after due date shown above] 2 $ AMOUNT OF AMOUNT OF PREPAYMENT (place a check mark by the option you choose) annual Facility Fee at a site are not subject to a Generator Fee for the same site B Multiply amount on line A by 50% (line A x 0 50) enter the result here and on line 1 on front BEFORE PREPARING before the last day of August with a remittance payable to the State Board of Equalization This return must be filed even if BOARD OF EQUALIZATION BOE 501 FGP (BACK) REV 20 (4 13) BOE 501 FGP (FRONT) REV 20 (4 13) BOE USE ONLY calendar year CENTS TO CLASSIFICATION OF GENERATING SITES conditional authorization or conditional exemption However hazardous waste generated by the treatment unit is subject to Control disposal or management of hazardous waste including the payment of the Hazardous Waste Generator Fee However the DOLLAR DUE ON OR BEFORE Each year a prepayment of the fee is due by August 31 and an annual return for the year must be filed by the last day of EMAIL ADDRESS examined by me and to the best of my knowledge and belief is true correct and complete EXEMPTIONS FROM THE FEE Failure to file either the prepayment or annual return may result in the imposition of penalties Facility operators who pay an February following the end of the reporting period An annual return must be filed even if no additional Generator Fee is due Federal Government is not liable for interest imposed by the California Revenue and Taxation Code Federal Hazardous Waste Generator Fee annual return This amount is exclusive of any FEDERAL LIABILITY FOR THE FEE FEDERAL PREPAYMENT FILING REQUIREMENTS FILING REQUIREMENTS from the main menu select the option Special Taxes and Fees front page) $ GENERAL INFORMATION hazardous waste generated for all sites during January 1 through June 30 of the current HAZARDOUS WASTE GENERATOR FEE PREPAYMENT FORM FEDERAL I hereby certify that this form including any accompanying schedules and statements has been If you need additional information please contact the State Board of Equalization Special Taxes and Fees P O Box 942879 Sacramento CA in each calendar year The fee is calculated for generation of waste at each site regardless of the waste's final disposition January 1 through June 30 of the current calendar year) list tonnage) NUMBER OF SITES Option 1 One hundred percent (100%) of the applicable Generator Fee based on the total volume of OPTION 1 WORKSHEET Option 2 An amount equal to fifty percent (50%) of the Generator Fee paid to the BOE for the entire OPTION 2 WORKSHEET page $ Payments: You can make your payment by paper check Online ACH Debit (ePay) or by credit card To use ePay go to our Please complete the worksheets on the reverse to calculate total amount due below Please select the appropriate fee category for each site that generated hazardous waste in this state PO BOX 942879 preceding calendar year (if zero for prior year you must use Option 1) prepayments or penalties (if zero for the prior period you must use Option 1) $ RA B/A AUD REG READ INSTRUCTIONS ROUND RR QS FILE REF SACRAMENTO CA 94279 6033 SIGNATURE PRINT NAME AND TITLE SPECIAL TAXES AND FEES STATE OF CALIFORNIA TELEPHONE the Generator Fee The Generator Fee is imposed on each person that generates (produces) hazardous waste of five (5) tons or more at a site TOTAL FEE Under 42 U S C section 6961 federal departments instrumentalities or agencies are subject to state regulation concerning Under section 43152 15 of the Hazardous Substances Tax Law a prepayment of the fee by site is due and payable on or website or call 1 855 292 8931 Mandatory EFT accounts must pay by EFT or ePay Be sure to sign and mail your return WHOLE worksheet and enter the option chosen and amount due on the front of the form www boe ca gov website at click on the eServices tab and log in to make a payment To pay by credit card go to our You can determine the prepayment amount you owe by using either Option 1 or Option 2 below Complete the applicable you have no tax liability Under section 43155 of the Hazardous Substances Tax Law late payment will result in a 10 percent YOUR ACCOUNT NO