Form Boe-501-Hfp2 - Hazardous Waste Facility Fee Prepayment Form Second Prepayment
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1
2
3STATE OF CALIFORNIA
BOE-501-HFP2 (S1F) REV. 13 (4-13)
BOARD OF EQUALIZATION
HAZARDOUS WASTE FACILITY FEE PREPAYMENT FORM
SECOND PREPAYMENT
BOE USE ONLY
RA-B/A
AUD
REG
DUE ON OR BEFORE
RR-QS
FILE
REF
YOUR ACCOUNT NO.
[
]
FOID
EFF
BOARD OF EQUALIZATION
SPECIAL TAXES AND FEES
PO BOX 942879
SACRAMENTO CA 94279-6013
READ INSTRUCTIONS
BEFORE PREPARING
B
A
AMOUNT OF
CLASSIFICATION OF FACILITY SITES
FEE RATE
FEE DUE
1. Disposal facility (if you are a government agency, please see instructions
$
$
1.
on reverse)
2. Large onsite treatment facility
2.
3. Large offsite treatment facility
3.
4. Small treatment facility
4.
5. Minitreatment facility
5.
6. Large storage facility
6.
7. Small storage facility
7.
8. Ministorage facility
8.
9. Standardized permit facility - (enter fee for appropriate category) 9(a).
SERIES A
9(b).
SERIES B
9(c).
SERIES C
SERIES C
9(d).
(Sm. Qty.)
10. Postclosure permit facility - within the first five years of the
10(a).
SMALL
postclosure period (enter fee for appropriate category)
10(b).
MEDIUM
10(c).
LARGE
11. Postclosure permit facility - beyond the first five years of
11(a).
SMALL
the postclosure period (enter fee for appropriate category)
11(b).
MEDIUM
11(c).
LARGE
12. Enter amount of highest applicable fee rate from column B
12.
$
13. Less fee paid with first prepayment
13.
$
14. Total fee due (subtract line 13 from line 12)
14.
$
15. Penalty [multiply line 14 by 10% (0.10) if payment is made after due date shown above]
$
15.
PENALTY
16.
INTEREST: One month's interest is due on the fee for each month or fraction of a month
16.
$
INTEREST
that payment is delayed after the due date. The adjusted monthly interest rate is
17. TOTAL AMOUNT DUE AND PAYABLE (add lines 14, 15, and 16)
17.
$
EMAIL ADDRESS
I hereby certify that this form, including any accompanying schedules and statements, has been
examined by me and to the best of my knowledge and belief is true, correct, and complete.
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.
CLEAR
PRINT
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