Hazardous Waste Fee Report - Emelle, Alabama Facility - Alabama Department Of Revenue

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LABAMA

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P.O. Box 327555 • Montgomery, AL 36132-7555 • (334) 353-7827

Hazardous Waste Fee Report – Emelle, Alabama Facility

REQUIRED BY ACT NOS. 92-658, 2006-306 AND 2007-594

Online filing available at

___________________________________

For the Month of

COMPANY

FEIN

OR

ADDRESS

SSN

CITY

STATE

ZIP

ACCOUNT NUMBER

CONTACT PERSON

TELEPHONE NUMBER

(

)

A

B

C

D

HAZARDOUS WASTE OR

TOTAL TONS RECEIVED

FEE RATE

FEE COLLECTED

HAZARDOUS SUBSTANCE

FOR DISPOSAL

1 Waste listed under Section 3001 of the RCRA of 1976

21 60

1

1

1

as amended and “PCB” waste . . . . . . . . . . . . . . . . . . . . . . . .

2 Acute hazardous waste listed in 40 CFR 261.33(e)

and having an EPA hazardous waste number

83 60

2

2

2

designation beginning with letter “P” . . . . . . . . . . . . . . . . . . .

3 Toxic hazardous waste listed in 40 CFR 261.33(f) and

having an EPA hazardous waste number designation

46 60

3

3

3

beginning with letter “U” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 Emission control dust/sludge from the primary

11 60

4

4

4

production of steel in electric arc furnaces (K061) . . . . . . .

5 Any hazardous waste that is de-characterized

11 60

5

5

5

and rendered nonhazardous . . . . . . . . . . . . . . . . . . . . . . . . . .

11 60

6

6

6

6 All other waste . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7

7

7 TOTAL TONS (Col. B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TOTAL FEE (Col. D) . . . . .

8

8 Additional fee ($1.00 per ton disposed). (Enter total tons – _____________________________ ) . . . . . . . . . . . . . . . . . . . .

9

9 TOTAL FEE (Add fees on lines 7 & 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10

10 Failure to Timely File Penalty (Late filing, greater of 10% of Total Fee or $50) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11

11 Failure to Timely Pay Penalty (Late payment, 10% of Total Fee). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12

12 Failure to Submit Monthly Report (Penalty not to exceed $250.00) (22-30B-06). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13

13 Failure to Timely Pay Penalty (10% of fee due) (22-30B-05) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14

14 Interest (Code of Alabama 1975, Section 40-1-44) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15

15 TOTAL AMOUNT DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If payment made through Electronic Funds Transfer (EFT) check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

AFFIDAVIT

STATE OF ALABAMA, COUNTY OF ___________________________________________________________________

Before me, the undersigned authority, personally appeared ________________________________________________________________________________ who being by me first duly sworn,

deposes and says that he is a duly authorized representative of _______________________________________________________________________________________________________

and the information herein contained is true and correct.

_________________________________________________________________________

SIGNATURE OF DEPONENT

Sworn to and subscribed before me

this _______________ day of _______________________________________ , _____________ .

_________________________________________________________________________

NOTARY PUBLIC

NOTE: The return and remittance are due no later than the thirtieth (30th) day of the month for the previous calendar month’s activity. A return is

due regardless of activity.