Form Boe-501-Hg - Hazardous Waste Generator Fee Return
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4STATE OF CALIFORNIA
BOE-501-HG (S1F) REV. 20 (4-13)
BOARD OF EQUALIZATION
HAZARDOUS WASTE GENERATOR FEE RETURN
BOE USE ONLY
AUD
RA-B/A
REG
DUE ON OR BEFORE
FILE
RR-QS
REF
YOUR ACCOUNT NO.
[
]
FOID
EFF
BOARD OF EQUALIZATION
SPECIAL TAXES AND FEES
PO BOX 942879
SACRAMENTO CA 94279-6009
READ INSTRUCTIONS
BEFORE PREPARING
Please check this box if sites below include Treated Wood Waste.
1.
Please check this box if you no longer generate hazardous waste at this site. Enter the date of last generation:
____________________________________________
. Your account will be closed as of the date entered. For consolidated
accounts, use the enclosed Schedule G to indicate the date each site last generated waste if hazardous waste is no
longer being generated at that site.
A
B
C
D
NUMBER
CLASSIFICATION OF GENERATING SITES
AMOUNT OF
TOTAL FEES
OF SITES
FEES
DUE
(Based on amounts of hazardous waste generated
(Do not
during the calendar year or portion thereof)
list tonnage)
(column B x C)
2.
Generators which generate less than 5 tons
2.
3.
Generators which generate an amount equal to or more than
3.
5 tons, but less than 25 tons
4.
Generators which generate an amount equal to or more than
4.
25 tons, but less than 50 tons
5.
Generators which generate an amount equal to or more than
5.
50 tons, but less than 250 tons
6.
Generators which generate an amount equal to or more than
6.
250 tons, but less than 500 tons
7.
Generators which generate an amount equal to or more than
7.
500 tons, but less than 1,000 tons
8.
Generators which generate an amount equal to or more than
8.
1,000 tons, but less than 2,000 tons
9.
Generators which generate an amount equal to or more than
9.
2,000 tons
10. Amount of fees (add lines 3 through 9 in column D)
10.
$
11. Less prepayment credit
11.
$
12. Total fee due (subtract line 11 from line 10)
12.
$
13. Penalty [multiply line 12 by 10% (0.10) if payment is made after the due date shown
13.
$
PENALTY
above]
14.
INTEREST: One month's interest is due on the total fee for each month or fraction of a month that
14.
$
INTEREST
payment is delayed after the due date. The adjusted monthly interest rate is
15. TOTAL AMOUNT DUE AND PAYABLE (add lines 12, 13, and 14)
15.
$
EMAIL ADDRESS
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.
SIGNATURE
PRINT NAME AND TITLE
TELEPHONE
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.
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