STATE OF CALIFORNIA
BOE-501-FFP (S1F) REV. 13 (4-13)
BOARD OF EQUALIZATION
HAZARDOUS WASTE FACILITY FEE PREPAYMENT FORM - FEDERAL
BOE USE ONLY
FIRST PREPAYMENT
RA-B/A
AUD
REG
DUE ON OR BEFORE
RR-QS
FILE
REF
[
]
YOUR ACCOUNT NO.
FOID
EFF
BOARD OF EQUALIZATION
SPECIAL TAXES A a ND FEES
PO BOX 942879
SACRAMENTO CA 94279-6015
READ INSTRUCTIONS
BEFORE PREPARING
A
B
ANNUAL
AMOUNT OF
CLASSIFICATION OF FACILITY SITES
FEE RATE
FEE DUE
1.
$
$
1. Disposal facility (if you are a government agency please see instructions 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(a).
11. Postclosure permit facility - beyond the first five years of the
SMALL
postclosure period (enter fee for appropriate category)
11(b).
MEDIUM
11(c).
LARGE
12. Calculate prepayment due (must not be less than 50% (0.50) of the highest permitted fee category)
12.
$
$
13. Penalty [multiply line 12 by 10% (0.10) if payment is made after due date shown above]
13.
PENALTY
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 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