Facility Fee Calculation Worksheet - Kansas Department Of Health & Environment
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1Facility Name___________________________________________
Please enclose payment with fee worksheet & Tier II form.
Make check payable and mail to:
Address ______________________________________________
Kansas Department of Health & Environment
Address ______________________________________________
Right-To-Know Program
1000 SW Jackson, Suite 330
County ________________________
Report Year___________
Topeka KS 66612
FACILITY FEE CALCULATION WORKSHEET
A.
SECTION 312 TIER II - EXTREMELY HAZARDOUS SUBSTANCE (EHS)
1.
Total all reportable quantities in pounds of EHS on site at a facility at any one time in Box “a”.
2.
Review the schedule below for range category of your EHS total, for Box “a”’ and associated fee.
3.
Place fee amount on Line A.
Range in Pounds
Fee
A. $ ________________
a
1
- 9,999
$25
10,000
- 999,999
$50
1,000,000
or above
$150
B.
SECTION 312 TIER II - OTHER HAZARDOUS CHEMICALS
1.
Total all reportable quantities in pounds of hazardous chemicals (excluding EHS’s, petroleum fuels
reporting under the storage tank program, sand, gravel, clay, salt, or brine) onsite at any one time in Box “b”.
2.
Review the schedule below for range category of your total hazardous chemicals and associated fee.
3.
Place fee amount on Line B.
Range in Pounds
Fee
B. $ _________________
b
10,000
- 99,999
$25
100,000
- 999,999
$50
1,000,000
- 9,999,999
$150
10,000,000
- or above
$300
4.
Is facility reporting petroleum fuels to KDHE’s Storage Tank Program?
YES
or
NO
If YES, do not include those quantities of petroleum fuels in calculating the hazardous chemical fee.
C.
SECTION 313 FORM R - EMISSIONS (DUE WHEN FILING THE SECTION 313 TRI REPORT)
1.
Total all emission quantities from Form R for each facility and enter in Box “c”.
2.
Review the schedule below for range category of your emission total and associated fee.
3.
Place fee amount on Line C.
4.
Facilities utilizing EPA’s alternate threshold and certificate statement are required to pay the $250 fee
if their emissions are above 100 pounds.
Range in Pounds
Fee
C. $ __________________
c
100
- 19,999
$250
20,000
- 99,999
$700
100,000
- 999,999
$1700
1,000,000
- or above
$3000
D.
TOTAL LINES “A”, “B”, AND “C” AND ENTER ON LINE “D”.
D. $ _________________
E.
IF UTILIZING AGGREGATE FACILITY REPORTING.
E. $ ________________
Number of facilities
x “D”
F.
COMPARE EITHER LINE “E” IF UTILIZING AGGREGATE REPORTING, OR LINE “D” IF NOT UTILIZING
F. $ ________________
AGGREGATE REPORTING, TO $3000 AND PLACE SMALLER AMOUNT ON LINE “F”.
LINE “F” IS THE FEE YOU ARE REQUIRED TO PAY.
G.
OIL AND GAS EXPLORATION FACILITIES ONLY
G. $ ________________
1.
Owner/operators of oil or gas wells, as defined by K.S.A. 55-150, will pay a flat $25 filing fee.
2.
Place fee amount on Line G. (This is your only fee.)
Amount Paid________________
Check # __________________
For Office Use Only
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