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ET-501-HG FRONT REV.3 0-921 P.O.BOX54 BOARD OF EOI TION BOARD USE ONLY <br /> STATE OF CALIFORNIA SACRAM CA 94291-2754 SPECIAL T VISION <br /> HAZARDOUS WASTE GENERATOR FEE AND (9' a-9555 REG RR PR <br /> WASTE REPORTING SURCHARGE FEE RETURN TR AUD NR <br /> DUE ON OR BEFORE 01/31/94 FOR JANUARY - DECEMBER 1993 REF OD PI <br /> Mail To: HWCA RVH601 9193 HA HQ 36-033192 4 FILE <br /> STATE BOARD OF EQUALIZATION <br /> SPECIAL TAXES DIVISION NEWARK SIERRA PAPERBOARD CORP <br /> P.O. BOX 942754 800 W.CHURCH ST <br /> SACRAMENTO, CA 94291-2754 STOCKTON CA 95203-3206 <br /> READ INSTRUCTIONS <br /> BEFORE PREPARING <br /> CAD981375157 Make Changes If Name <br /> 800 W.CHURCH ST, STOCKTON or Address is Incorrect <br /> B <br /> A NUMBER C TOTAL FEES <br /> OF .T"' AMOUNT OF DUE <br /> CLASSIFICATION OF GENERATING SITES (Do not FEES (Col B x C) <br /> list tonnage) <br /> Generators which generate less than <br /> 1. 5 tons of hazardous waste during the 0.00 - <br /> calendar year or portion thereof. <br /> Generators which generate an amount equal to or more <br /> 2. than 5 tons, but less than 25 tons,of hazardous 147.00 <br /> waste during the calendar year or portion thereof. <br /> Generators which generate an amount equal to or more <br /> 3. than 25 tons, but less than 50 tons, of hazardous I / 1 184 4 00 / jp� Q-D <br /> waste during the calendar year or portion thereof. <br /> Generators which generate an amount equal to or more <br /> 4. than 50 tons, but less than 250 tons,of hazardous 2959.00 <br /> waste during the calendar year or portion thereof. <br /> Generators which generate an amount equal to or more <br /> 5. than 250 tons, but less than 500 tons, of hazardous 14796.00 <br /> waste during the calendar year or portion thereof. <br /> Generators which generate an amount equal to or more <br /> 6. than 500 tons, but less than 1,000 tons,of hazardous 29591 -00 <br /> waste during the calendar year or portion thereof. <br /> Generators which generate an amount equal to or more <br /> 7. than 1,000 tons, but less than 2,000 tons, of hazardous 44386.00 <br /> waste during the calendar year or portion thereof. <br /> Generators which generate an amount equal to <br /> 8. or more than 2,000 tons of hazardous waste 59182.00 <br /> during the calendar year or portion thereof. <br /> 9. Total amount of fees. (Add amounts in Column D, Lines 1 thru 8) $ <br /> 10. See instructions for credit for local fees. $ 137, <br /> Oa <br /> 11. Total amount of fees due. <br /> (Subtract Line 10 from Line 9. If Line 11 is less than zero, enter zero.) $,1110 c// <br /> 7, (� <br /> 12. Penalty of 10% (.10) it payment is made after due date shown above. Penalty $ <br /> 13 INTEREST OF 10PER ANNUM (0-00833-3--PER MONTH Interest $ <br /> IS DUE IF PAYMENT IS MADE AFTER THE DUE DATE. <br /> 14. TOTAL AMOUNT DUE AND PAYABLE. (Add lines 11, 12, 13) I $ /0 q7,� <br /> hereby ce I a nIs return, including any accompanying schedules an statements, nas Fen 6 <br /> examined by me and to the best of my knowledge and belief is a true, correct and complete return. <br /> shy, etre r- (Zl) 1<16 G J2 <br /> MAKE CHECK OR MONE ORDER PAYABLE TO STATE BOARD OF EQUALIZATION. <br /> Ahuava wrap vnur ac-nun, number on vour check or monev order. Make a coov of this document for vour records. <br />