Form Boe-501-Sq - Integrated Waste Management Fee Return
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1
2BOE-501-SQ (FRONT) REV. 12 (7-07)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
INTEGRATED WASTE MANAGEMENT FEE RETURN
BOARD USE ONLY
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 94279-6093
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. You are to
report all solid waste accepted at each disposal site during the above calendar quarter.
ROUND TO THE
I. OPERATIONS
NEXT WHOLE TON
1a. Total tons of solid waste accepted during above calendar quarter
1a.
.0
1b. Total tons of clean soil accepted and not disposed during the above calendar quarter
.0
1b.
2.
2.
Total operating days for above calendar quarter
.0
*
3.
Average tons of solid waste accepted per operating day (divide line 1a by line 2)
3.
*
IF THE AMOUNT ON LINE 3 IS LESS THAN 5 TONS, ENTER A ZERO ON LINE 10 AND THEN 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 solid waste accepted during above calendar quarter (from line 1a above)
4.
.0
(-)
.0
5.
Tons of waste removed from waste stream and reused, recycled, or composted off-site
5.
6.
Total tons of waste removed from waste stream and used on-site for beneficial reuse
6.
(-)
.0
a. Tons of waste removed from waste stream for beneficial reuse on-site as
.0
alternative daily cover
b. Tons of waste removed from waste stream for beneficial reuse on-site as
.0
alternative intermediate cover
c. Tons of waste removed from waste stream and used on-site for other
.0
non-cover beneficial reuse purposes
7.
Other waste removed from the waste stream and not disposed of in a disposal facility
7.
(-)
.0
or otherwise exempt from the fee (attach letter of explanation)
TOTAL TONS OF SOLID WASTE SUBJECT TO THE FEE (subtract lines 5, 6, and 7 from line 4)
8.
8.
.0
III. FEE
9.
Rate of fee per ton
$
9.
10.
FEE DUE (multiply tonnage on line 8 by the rate of fee on line 9)
10.
$
Penalty [multiply line 10 by 10% (0.10) if payment is made after due date
11.
$
PENALTY
11.
shown above]
12.
INTEREST: One month's interest is due on the total fee for each month or fraction of a month that
INTEREST
12.
$
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
TELEPHONE NUMBER
DATE
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.
PRINT
CLEAR
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