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SGHEpULE C -- FEE:$ SUMMARY SHEET (3008 manifests) <br />(See back of lh(,T form`for complele 1pslrucffoFis,1 <br />SrCTI.QN A &FA.tD.NUMBER VERIFICATION FEE (j 1, X008 -June:30,2009) <br />1. .Nagiedfyour.orgenlzstion: (Reguirad) 7iDrY.•r ArM�ca4 ) j1+.1i,n /�1 .. ri0cr ftlYal' <br />2. Fedorel Employer I Vumber(FEIN); (Ragt,ttod)_ 13 = iaJ 2 1 <br />Ihpoli do nbf Have a Feddrol:Employer ID bfumber,.please provide your -Social &a unity Number. (Also tatted n Fedoipr7px tD.) <br />3, Enter the total number of persons employed by youl orgablzelion In Californl9: 2_ 1 „ (See reverse.) <br />Q: <br />v Yka1.Rr:n,n numnervormcatlon Foos not. to exceed $9000) <br />Eltlerthe EFA LD Npinbq( Vsr)tIdatlon Fee [ate from the la ze above. <br />5. <br />Enter Uta total number of permanent EPA ID Numbers held by your organization rind active at anytlmv <br />g _ <br />dudn9 July 1, 2008 - June 30,'2009. Attac)l-a Verincallon Qirostlonnalro'(page 1) and Schedule A for <br />oath pormanencEPA IO,Nurrmtter. <br />r <br />Exclijdb riumbers begtnnfng with `CAG' gr'(:API. <br />Multfpfy the $.Anjounlla A.d: by the.number In. AA <br />$ <br />7,, <br />TOTAL I?PA I6 NUf4.BERyERIFiCg7tON FEEpU6. (Etiterlhe dolfarambunl frgirY l;foa.AG: <br />Wive OR $6000, WbIchovor amounlis.ioss.) <br />—� <br />$ ^ <br />S,EOTIM B - MANIFEST FEF_ -(January-!, 26d8;- t)ecember3'l, 2008) <br />1. <br />Frilet Iho.�oliar amount oti.Line e.+irom yourrSchedule A.� Manifest Fee. Cslculallon Sheol, If.you are. <br />reporting more-1han ono Ip-Numbat, onter.lhe'TOTAL dflh�dgllar ampprlti; Iri Line e. frojn kli ofyqur <br />Scheduio.A-Manifest Fee Calculaiion'Sheeis. <br />$ Q <br />2. <br />Cerefully rap(i the hl$tfuCtl0111511Slerl or ihelack-tri $action 8-1 before completing this section. <br />If.ytlur bubjna44 has lo: 'than 1.00.cinployges; thg first four non•recycled <br />manlfgsts used In the 2608 <br />calendar year aro free. (Manifests used 3-olgjy: for hayardous v1asto derived ffQm air,Ogmpllonce <br />.solverils. are oxciuded.arid,Cannot he clolmed as free:). <br />m to 11 (n:Arder to r89oiVo-the crodlt,.you must list tho manifest numbor(s) for each of,tho non- <br />reoyc ed man$ost(s) you aro claiming as free, Please cheek your tecords for mtirtiltost numbers. If you <br />d4 not have o copy o(your manifeat(s), cenlaet yqur hazardous -was to' <br />transporter. <br />Q0Q6393 UR .6030LUW9 11 QQ2onM 86 trr F 0p�1, r� t 1JS <br />3. Enter -the numberof non•rccyclod rjmenJfe$Is GJgtnied free. If none, Wave blenh. rr�--�,� X sno,trr6ol.c. $ <br />L� aa 60 <br />4: MANIFEST FEE DUE FOR 200.8 MANIFESTS (Subtract$ In Line 13.3. from Line B,t.) <br />SECTION C - GRAND.TOUL QF E. {A !D N.UVOE.R.VERIFICATION FEES A.N1).MANtFEST F"S <br />Addllie $'ontount in A.7 and dme $ amount B.4. Entt r me total: TOTAL- FEE DUE: $._i �a <br />'If. yoo do,notbyvo any fees;.yoil.{I -$ flfrequlrerl to.compfefe and subtnff olf forms, <br />If pgyjng by chgck; make cheek payable td DTSCB ivfie one of vour EPA IO Numbars on Ygur clLpd. <br />If you oro poyinlj by cred(t bard,.use th'g enclosod credlt'cord (Orin. <br />f her$6y certify udder p6Ne((y Of porfury fhM the hifojmallorr on;scliedule A(s) and -Schedule 8.Is, true -and correct. <br />Slgnaturq Of Preparer.��}� � . _ title:�y,�,�,` <br />Nemo (ploaye print): _ "u�r�t <br />Date: '7- Q - Obi Mns: ' . Qa�1-aZ <br />I <br />I►iCtUU.UWINQ-DOCUME*TS-WITHIN:80-DAY£ <br />WrIflolion Quoxlioriiioi(a (o)11e`Vaiiricellon Qu6sllonnalre for each EPA ID Number) <br />Schedule A - MenlrostFee Caleuletlon Sheet (One ScheduloA.for each EPA ID. Number) I <br />Schedule B - Feo Summary Sheel (only ono Schedule B Is needed for your entire organlzallon) <br />P.aym9nl Duo, if.any. <br />11948 - IFRONTI 141091 <br />(L <br />