Form BOE-501-HGP Fillable Hazardous Waste Generator Fee Prepayment Form

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( COLUMN C AMOUNT OF FEES $) (3 INTEREST: One month's interest is due on the total fee for each month or fraction of a month that payment is delayed after the due date The adjusted monthly interest rate is) (Amount of prepayment (enter amount from worksheet on reverse) $ 00) (BOE USE ONLY ) (button) CLEAR (button) PRINT (COLUMN 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 COLUMN B NUMBER OF SITES (Do not list tonnage) ) (COLUMN 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 COLUMN B NUMBER OF SITES (Do not list tonnage) ) (COLUMN 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 COLUMN B NUMBER OF SITES (Do not list tonnage) ) (COLUMN 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 COLUMN B NUMBER OF SITES (Do not list tonnage) ) (COLUMN 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 COLUMN B NUMBER OF SITES (Do not list tonnage) ) (COLUMN 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) ) (COLUMN 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) ) (COLUMN 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) ) (COLUMN 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) 9 TOTAL AMOUNT DUE (add lines 1 through 8 in column D; enter here and on line 1 on front page) D TOTAL FEE DUE (Column B x C) $ ) (COLUMN AMOUNT OF FEES $ ) (Column B x C) (COLUMN C AMOUNT OF FEES $ ) (COLUMN C AMOUNT OF FEES $ ) (COLUMN C AMOUNT OF FEES $ ) (COLUMN C AMOUNT OF FEES $) (COLUMN D TOTAL FEE DUE (Column B x C) $ ) (COLUMN D TOTAL FEE DUE (Column B x C) $ ) (COLUMN D TOTAL FEE DUE (Column B x C) $ ) (COLUMN D TOTAL FEE DUE (Column B x C) $ ) (DATE) (Do not (DUE ON OR BEFORE) (EMAIL ADDRESS) (INTEREST: $ 00) (OPTION 2 WORKSHEET A Enter amount of fee due to the BOE for the entire prior year as reported on line 10 of the 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) D TOTAL FEE DUE (Column B x C) $ ) (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) D TOTAL FEE DUE (Column B x C) $ ) (Penalty [multiply line 1 by 10% (0 10) if payment is made after due date shown above] $ 00) (PRINT NAME AND TITLE) (TELEPHONE AREA CODE ( )) (TELEPHONE) (text) (text) (text) (TOTAL AMOUNT DUE AND PAYABLE (add lines 1 2 and 3) $ 00) (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 1 Generators which generate less than 5 tons per site 1 Amount of prepayment (enter amount from worksheet on reverse) 1 $ 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 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 3 Generators which generate an amount equal to or more than 3 INTEREST: One month's interest is due on the total fee for each month or 3) Aqueous waste treated onsite in a treatment unit operating or which subsequently operates under a permit by regulation 4 4 Generators which generate an amount equal to or more than 4 TOTAL AMOUNT DUE AND PAYABLE (add lines 1 2 and 3) 4 $ 5 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 6 Generators which generate an amount equal to or more than 7 7 Generators which generate an amount equal to or more than 8 8 Generators which generate an amount equal to or more than 9 9 $ 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) 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 BOARD OF EQUALIZATION BOE 501 HGP (BACK) REV 20 (4 13) BOE 501 HGP (FRONT) REV 20 (4 13)STATE OF CALIFORNIA BOE USE ONLY calendar year CENTS TO CLASSIFICATION OF GENERATING SITES Code Facility operators who pay an annual Facility Fee at a site are not subject to a Generator Fee for the same site conditional authorization or conditional exemption However hazardous waste generated by the treatment unit is subject to Control disposition (for example recycling or disposal) DOLLAR DUE ON OR BEFORE EMAIL ADDRESS examined by me and to the best of my knowledge and belief is true correct and complete EXEMPTIONS FROM THE FEE FEE PREPAYMENT FORM FILING INSTRUCTIONS FILING REQUIREMENTS fraction of a month that payment is delayed after the due date The adjusted 3 $ 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 Hazardous Waste Generator Fee annual return This amount is exclusive of any 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 each site's generation of waste at each site regardless of the waste's final January 1 through June 30 of the current calendar year) list tonnage) monthly interest rate is must be filed even if no additional Generator Fee is due Failure to file either the prepayment or annual return may result in NEAREST 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 payable on or before the last day of August with a remittance payable to the State Board of Equalization An annual return Payments: You can make your payment by paper check Online ACH Debit (ePay) or by credit card To use ePay go to our percent (0 10) penalty and interest at an adjusted annual rate established under section 6591 5 of the Revenue and Taxation Please complete the worksheets on the reverse to calculate the 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) PREPAYMENT FILING REQUIREMENTS 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 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 the imposition of penalties Under section 43155 of the Hazardous Substances Tax Law late payment will result in a 10 TOTAL AMOUNT DUE (add lines 1 through 8 in column D; enter here and on line 1 on TOTAL FEE Under section 43152 15 of the Hazardous Substances Tax Law a prepayment of the Generator Fee by site is due and 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 1 855 292 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 You can determine the prepayment amount you owe by using either Option 1 or Option 2 below Complete the applicable YOUR ACCOUNT NO

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