STATE OF CALIFORNIA
BOE-501-NW (FRONT) REV. 5 (7-07)
BOARD OF EQUALIZATION
INTEGRATED WASTE MANAGEMENT FEE RETURN
BOARD USE ONLY
NONHAZARDOUS WOOD WASTE FACILITY
RA-B/A
AUD
REG
DUE ON OR BEFORE
RR-QS
FILE
REF
YOUR ACCOUNT NO.
[
]
FOID
EFF
BOARD OF EQUALIZATION
ENVIRONMENTAL FEES DIVISION
PO BOX 942879
SACRAMENTO CA 94279-6095
READ INSTRUCTIONS
BEFORE PREPARING
This return must be filed on or before the due date shown above by every person who operates a disposal facility accepting
nonhazardous wood waste exclusively and is required to have a solid waste facilities permit. You are to report all nonhazardous
wood waste accepted at each disposal site during the above calendar quarter.
ROUND TO THE
I. OPERATIONS
NEXT WHOLE TON
1. Total tons of nonhazardous wood waste accepted during above calendar quarter
1.
.0
2. Total operating days for above calendar quarter
2.
.0
*
3. Average tons of nonhazardous wood waste accepted per operating day (divide line 1 by line 2)
3.
*
IF THE AMOUNT ON LINE 3 IS LESS THAN 5 TONS, ENTER A ZERO ON LINE 10 AND SIGN AND DATE THE RETURN. IF THE AMOUNT
ON LINE 3 IS EQUAL TO OR GREATER THAN 5 TONS, CONTINUE ON TO THE NEXT SECTION.
ROUND TO THE
II. DISPOSALS
NEXT WHOLE TON
4. Total tons of nonhazardous wood waste accepted during above calendar quarter (from line 1 above) 4.
5. Recycled nonhazardous wood waste removed from the waste stream and not disposed in
5.
(-)
.0
a disposal facility
6. Inert nonhazardous wood waste removed from the waste stream and not disposed in a
6.
(-)
.0
disposal facility
7. Other nonhazardous wood waste removed from the waste stream and not disposed in a
7.
(-)
disposal facility (attach letter of explanation)
.0
8.
8. TOTAL TONS OF NONHAZARDOUS WOOD WASTE SUBJECT TO THE FEE
.0
(subtract lines 5, 6, and 7 from line 4)
III. FEE
9. Rate of fee per ton
9.
$
FEE DUE (multiply tonnage on line 8 by the rate of fee on line 9)
10.
10.
$
11. Penalty [multiply line 10 by 10% (0.10) if payment is made after due date shown above]
$
11.
PENALTY
INTEREST: One month's interest is due on the total fee for each month or fraction of a month that
12.
12.
$
INTEREST
payment is delayed after the due date. The adjusted monthly interest rate is
13. TOTAL AMOUNT DUE AND PAYABLE (add lines 10, 11, and 12)
13.
$
IF PAID BY CREDIT CARD, CHECK HERE (Mandatory EFT accounts MUST pay by EFT). [ ]
I hereby certify that this return, including any accompanying schedules and statements, has been
examined by me and to the best of my knowledge and belief is a true, correct, and complete return.
YOUR SIGNATURE AND TITLE
DATE
TELEPHONE NUMBER
Make check or money order payable to State Board of Equalization.
Always write your account number on your check or money order. Make a copy of this document for your records.
CLEAR
PRINT