Form BOE-501-HFP2 Fillable Hazardous Waste Facility Fee Prepayment Form

Form BOE-501-HFP2 Fillable Hazardous Waste Facility Fee Prepayment Form - Second Prepayment

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$10 000 in column B for line 1 only (12 Enter amount of highest applicable fee rate from column B $) (13 Less fee paid with first prepayment $) (14 Total fee due (subtract line 13 from line 12) $) (15 PENALTY [multiply line 14 by 10% (0 10) if payment is made after due date shown above] $) (16 INTEREST $) (16 INTEREST: One month's interest is due on the fee for each month or fraction of a month that payment is delayed after the due date The adjusted monthly interest rate is ) (17 TOTAL AMOUNT DUE AND PAYABLE (add lines 14 15 and 16) $) (a) Postclosure permit small facility Manages 0 5 tons (1 000 pounds) or less of hazardous waste during any (B O E USE ONLY) (b) Postclosure permit medium facility Manages more than 0 5 (1 000 pounds) but less than 1 000 tons of (c) Postclosure permit large facility Manages 1 000 or more tons of hazardous waste during any one month of (CLASSIFICATION OF FACILITY SITES 10 Postclosure permit facility within the first five years of the postclosure period (enter fee for appropriate category) 10(a) SMALL Column A FEE RATE $) (CLASSIFICATION OF FACILITY SITES 10 Postclosure permit facility within the first five years of the postclosure period (enter fee for appropriate category) 10(b) MEDIUM Column A FEE RATE $) (CLASSIFICATION OF FACILITY SITES 10 Postclosure permit facility within the first five years of the postclosure period (enter fee for appropriate category) 10(c) LARGE Column A FEE RATE $) (CLASSIFICATION OF FACILITY SITES 11 Postclosure permit facility beyond the first five years of the postclosure period (enter fee for appropriate category) 11(a) SMALL Column A FEE RATE $) (CLASSIFICATION OF FACILITY SITES 11 Postclosure permit facility beyond the first five years of the postclosure period (enter fee for appropriate category) 11(b) MEDIUM Column A FEE RATE $) (CLASSIFICATION OF FACILITY SITES 11 Postclosure permit facility beyond the first five years of the postclosure period (enter fee for appropriate category) 11(c) LARGE Column A FEE RATE $) (CLASSIFICATION OF FACILITY SITES 2 Large onsite treatment facility Column A FEE RATE $) (CLASSIFICATION OF FACILITY SITES 3 Large offsite treatment facility Column A FEE RATE $) (CLASSIFICATION OF FACILITY SITES 4 Small treatment facility Column A FEE RATE $) (CLASSIFICATION OF FACILITY SITES 5 Minitreatment facility Column A FEE RATE $) (CLASSIFICATION OF FACILITY SITES 6 Large storage facility Column A FEE RATE $) (CLASSIFICATION OF FACILITY SITES 7 Small storage facility Column A FEE RATE $) (CLASSIFICATION OF FACILITY SITES 8 Ministorage facility 8 Column A FEE RATE $) (CLASSIFICATION OF FACILITY SITES 9 Standardized permit facility (enter fee for appropriate category) 9(a) SERIES A Column A FEE RATE $) (CLASSIFICATION OF FACILITY SITES 9 Standardized permit facility (enter fee for appropriate category) 9(b) SERIES B Column A FEE RATE $) (CLASSIFICATION OF FACILITY SITES 9 Standardized permit facility (enter fee for appropriate category) 9(c) SERIES C Column A FEE RATE $) (CLASSIFICATION OF FACILITY SITES 9 Standardized permit facility (enter fee for appropriate category) 9(d) SERIES C (Sm Qty ) Column A FEE RATE $) (CLASSIFICATION OF FACILITY SITES Disposal facility (if you are a government agency please see instructions on reverse) Column A FEE RATE $) (CLEAR) CLEAR (Column B AMOUNT OF FEE DUE $) (Column B AMOUNT OF FEE DUE $) (Column B AMOUNT OF FEE DUE $) (Column B AMOUNT OF FEE DUE $) (Column B AMOUNT OF FEE DUE $) (Column B AMOUNT OF FEE DUE $) (Column B AMOUNT OF FEE DUE $) (Column B AMOUNT OF FEE DUE $) (Column B AMOUNT OF FEE DUE $) (DATE) (DUE ON OR BEFORE) (EMAIL ADDRESS) (PRINT NAME AND TITLE) (PRINT) PRINT (Sm Qty ) (TELEPHONE (AREA CODE)) (TELEPHONE) (text) (text) (text) (YOUR ACCOUNT NO ) [ FOID ] 1 Disposal facility (if you are a government agency please see instructions 10 000 pounds per calendar month 10 Postclosure permit facility within the first five years of the 10(a) 10(b) 10(c) 11 Postclosure permit facility beyond the first five years of 11(a) 11(b) 11(c) 12 Enter amount of highest applicable fee rate from column B 12 $ 13 Less fee paid with first prepayment 13 $ 14 Total fee due (subtract line 13 from line 12) 14 $ 15 Penalty [multiply line 14 by 10% (0 10) if payment is made after due date shown above]PENALTY 15 $ 16 INTEREST: One month's interest is due on the fee for each month or fraction of a month 17 TOTAL AMOUNT DUE AND PAYABLE (add lines 14 15 and 16) 17 $ 2 Large onsite treatment facility 2 3 Large offsite treatment facility 3 4 Small treatment facility 4 5 000 gallons but less than 50 000 gallons per calendar month or total volume of solid hazardous waste treated is 5 Minitreatment facility5 50 000 gallons per calendar month or total volume of solid hazardous waste treated is greater than 100 000 6 Large storage facility 6 7 Small storage facility 7 8 Ministorage facility 8 9 Standardized permit facility (enter fee for appropriate category) 9(a) 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 facility fee is due from the facility operator for a facility that has been issued a postclosure permit The fee is due based upon Always write your account number on your check or money order Make a copy of this document for your records AMOUNT OF an adjusted annual rate established under section 6591 5 of the Revenue and Taxation Code and 11 applicable rate in column B for the proper fee category appropriate facility category on lines 1 through 8 becomes effective BEFORE PREPARING BOARD OF EQUALIZATION BOARD OF EQUALIZATION BOE 501 HFP2 (S1B) REV 13 (4 13) BOE 501 HFP2 (S1F) REV 13 (4 13) BOE 501 HFP2 (S2) REV 13 (4 13) BOE USE ONLY calendar month capacity and type of facility as specified in the permit Interim Status Document (ISD) or Federal Part A Application If your facility qualifies for categories category until you have been approved by DTSC to operate under a standardized permit Otherwise you should report under the category with the highest rate CLASSIFICATION OF FACILITY SITES Control (DTSC) to establish capacity and/or type If a facility's allowable capacity changes or is initially established as the result of certification DEFINITIONS FOR HAZARDOUS WASTE FACILITY FEE PREPAYMENT FORM delinquency charges included in your prepayment Disposal facility A facility used for the disposal of hazardous waste DUE ON OR BEFORE during any one month of the current fee period and submit a certification or permit modification to the Department of Toxic Substances EFF B O E USE ONLY EMAIL ADDRESS Enter in column B the rate for the highest category at which your facility is permitted for the current calendar year If you are a Equalization Under section 43155 of the Hazardous Substances Tax Law late payment will result in a 10 percent (0 10) penalty and interest at exceed 5 000 gallons per calendar month or total volume of solid hazardous waste treated does not exceed Facilities engaged in treatment and storage owe the highest fee to which the facility has ever been subject for the reporting period FACILITIES THAT CEASE TO OPERATE February following the current year FEE DUE fee for the reporting period immediately following the period during which the facility ceased disposal activity If your facility ceased activity on FEE RATE FILING REQUIREMENT from the main menu select the option Special Taxes and Fees gallons per calendar month or total volume of solid hazardous waste treated is less than 3 000 pounds per GENERAL government agency operating a disposal facility which did not dispose of hazardous waste during the reporting period enter greater than 10 000 pounds but less than 100 000 pounds per calendar month hazardous waste hazardous waste during any one month of the reporting period HAZARDOUS WASTE FACILITY FEE PREPAYMENT FORM SECOND hazardous waste or less than 100 000 pounds solid hazardous waste hazardous waste or less than 30 000 pounds solid hazardous waste I hereby certify that this form including any accompanying schedules and statements has beenexamined by me and to the best of my knowledge and belief is true correct and complete If you need additional information please contact the State Board of Equalization Special Taxes and Fees P O Box 942879 Sacramento CA If your permit ISD or Federal Part A does not state the facility capacity and/or type report at the highest level at which the facility operated immediately following the period during which the facility ceased actively treating or storing waste Disposal facilities must pay two times the INSTRUCTIONS FOR HAZARDOUS WASTE FACILITY FEE PREPAYMENT FORM intent to close INTEREST 16 $ LARGE Large onsite/offsite treatment facility Treats land treats or recycles 1 000 or more tons of hazardous waste Large storage facility Stores 1 000 or more tons of hazardous waste less than 500 000 gallons liquid hazardous waste or greater than 100 000 pounds but less than 500 tons solid Line 10 If the reporting period is within the first five years of the postclosure period select the appropriate facility size and enter the Line 11 If the reporting period is beyond the first five years of the postclosure period select the appropriate facility size and enter the Line 12 Enter the applicable fee rate If you are permitted for more than one category enter the highest fee for those permitted Line 13 Enter the amount of the fee paid with your first prepayment Your prepayment credit is the amount previously paid minus any Line 14 Subtract amount on line 13 from amount on line 12 Line 15 If your fee is paid after the due date penalty is due The penalty is 10 percent (0 10) of the fee due on line 14 The interest rate is Line 17 Add lines 14 15 and 16 and enter total amount due and payable including late charge if applicable Line 9 Line 9 Enter the applicable fee in column B if you are operating under a standardized permit Please note that you cannot report in this Lines 1 Lines 10 liquid hazardous waste or greater than 500 tons solid hazardous waste or any liquid or solid hazardous waste is Make check or money order payable to State Board of Equalization MEDIUM Ministorage facility Stores 0 5 tons (1 000 pounds) or less of hazardous waste Minitreatment facility Treats land treats or recycles 0 5 tons (1 000 pounds) or less of hazardous waste more than one category (full permit standardized permit or postclosure permit) during the fee period the amount due is the fee for the noted on line 16 on the front of this form and applies for each month or fraction thereof after the due date Offsite facility A hazardous waste treatment facility that is not an onsite facility on reverse) one month of the reporting period Onsite facility A hazardous waste treatment facility at which hazardous waste is produced and which is or after January 1 1994 you will be deemed to have ceased activity when you have actually ceased the activity and notified DTSC of your or Federal Part A If no capacity is stated you must report based on your actual operations or permit modification the fee that is due for the fee period in which the change occurs is the higher fee If a facility's type changes as the owned by leased to or under the control of the producer of the waste Payments: You can make your payment by paper check Online ACH Debit (ePay) or by credit card To use ePay go to our PO BOX 942879 postclosure period (enter fee for appropriate category) pounds per calendar month or any liquid or solid hazardous waste is stored for more than one calendar year PREPAYMENT Prepayments of the fee are due and payable by the last day of February and August of the current year The prepayments must be not less prepayments on or before the last day of February and August of the calendar year with a remittance payable to the State Board of RA B/A AUDREG READ INSTRUCTIONS result of a permit or ISD modification any change in the facility fee will be effective the fee period following the one in which the modification RETURN PREPARATION RR QS FILEREF SACRAMENTO CA 94279 6013 SERIES A Series A Standardized Permit (Storage) Total facility storage design capacity is greater than 500 000 gallons of Series A Standardized Permit (Treatment) Total influent volume of liquid hazardous waste treated is greater than SERIES B Series B Standardized Permit (Storage) Total facility storage design capacity is greater than 50 000 gallons but Series B Standardized Permit (Treatment) Total influent volume of liquid hazardous waste treated is greater than SERIES C Series C Small Quantity (Storage) Total facility storage design capacity is less than 15 000 gallons liquid Series C Small Quantity (Treatment) Total influent volume of liquid hazardous waste treated is less than 1 500 Series C Standardized Permit (Storage) Total facility storage design capacity is less than 50 000 gallons liquid Series C Standardized Permit (Treatment) Total influent volume of liquid hazardous waste treated does not SIGNATURE PRINT NAME AND TITLE SMALL Small storage facility Stores more than 0 5 tons (1 000 pounds) but less than 1 000 tons of hazardous waste Small treatment facility Treats land treats or recycles more than 0 5 tons (1 000 pounds) but less than 1 000 SPECIAL TAXES AND FEES STATE OF CALIFORNIA stored for more than one calendar year TELEPHONE than 50 percent (0 50) of the applicable fee See "Return Preparation" below An annual return will be due and payable on the last day of that payment is delayed after the due date The adjusted monthly interest rate is The annual Hazardous Waste Facility Fee is imposed pursuant to Health and Safety Code section 25205 2 based upon the allowable The following definitions apply to the facility's allowable capacity during any one month as stated in your permit ISD the postclosure period (enter fee for appropriate category) the reporting period the size of the facility Definitions of facility sizes are attached thru 8 tons of hazardous waste Under section 43152 12(a) of the Hazardous Substances Tax Law every facility operator who owes the facility fee is required to file two website at www boe ca gov click on the eServices tab and log in to make a payment To pay by credit card go to our website or call 1 855 272 8931 Mandatory EFT accounts must pay by EFT or ePay Be sure to sign and mail your return YOUR ACCOUNT NO

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