Form Boe-501-Fhg - Hazardous Waste Generator Fee Return - Federal
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4BOE-501-FHG (S1F) REV. 16 (4-13)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
HAZARDOUS WASTE GENERATOR FEE RETURN - FEDERAL
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 94279-6011
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
TOTAL FEES
CLASSIFICATION OF GENERATING SITES
AMOUNT OF
OF SITES
DUE
FEES
(Based on amounts of hazardous waste generated
(do not
(column B x C)
during the calendar year or portion thereof)
list tonnage)
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. Total 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 does not apply to this program
14.
INTEREST
15. TOTAL AMOUNT DUE AND PAYABLE (add lines 12 and 13)
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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