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10/30/95 0N:29 LDF GLASS LATHROP 002 <br /> �—elxn wo latr l REV.4 43.041 P• P427"s ENTO,CA 94291.2x$4 • STATE O7:CALIFORNIA <br /> IAA <br /> � BOARD OF£p(tq{_IZATION <br /> (111131 VS-VAS <br /> HAZARDOUS WASTE DISPOSAL FEE RETURN aDARD USE ONLY <br /> MC* RR <br /> DUE:ON OR BEFORE 4/30/94. FOR JANUARY - MARCH, 1994 <br /> TA ALA) NR <br /> AMOU31 NUMbal <br /> Mail To: HWCA 9VNW03 1494 HA HQ 36-009011 9 REF OD w <br /> STATE BOARD OF EQUALIZATION <br /> EENVIRONMENTALFEES DIVISION RISK MGMT-ENVIRONMENTAL AFFAIRS dt� <br /> PO BOX 942764 LISBEY—OWENS—FORD COMPANY <br /> SACRAMENTO CA 94291-2764 ATTEN: JON WEI$$ <br /> 500 E.LOUISE AVE PLANT I <br /> READ INSTR11CUOM <br /> 95330 <br /> LATHROP CA BEFORE PREPARING <br /> 500 E.LOUISE AVE PLANT I� LATHROP <br /> CADOO5415633 «addaake 6 pa �iect <br /> OATEOONESi A B C D <br /> fooln"kins ehatalNdl <br /> TOTAL ED OF E TA%Aou TON to ME NATE 4bIO11NT <br /> wapasEDDF (Rsundupto OFFEE <br /> BY 0ATE00RY whale heel loalumn b M CI <br /> 1. ROCYCIad(axcludos used oil removed ifrom a motor 1. /y <br /> Vehicle) 91, :;: � r1✓ ---. p 40 $:{^J <br /> �I. <br /> 2a. Nan-RCRA regulatod hazardous waste(generally 2a. - >. <br /> Includes asbestos) 5S. 2 0)D � <br /> 2b.Non-RCRA regulated hazardous waste,gareratea 21x. <br /> In•aamuP 80UDn(exarolift asbeelaa) <br /> 3. Mining waste <br /> 4. EKlremely hazardous waste 4. <br /> SEEN <br /> 5. Restricted waste 5. <br /> B._Hazardous waste 6. <br /> 7- Transported out of slate 7. ttl7fit q <br /> } <br /> A. Av*idues from incineration or dechlonnabon B <br /> of hazardous waste rj,25 <br /> 8. Total tee (add encs 1 through 8 in (iWtlmn O) 9. <br /> 10. Penalty (malliply line 0 by TO'%f.10)if payment IS made after due data indkaled above) PENALTY 10, <br /> 11, IN OF IOY PER ANNUM (0.006333 PER MONTH) INTEREST 11. <br /> IS DUE IF PAYMENT IS MDE AFTER THE DUE DATE. <br /> 12,TOTAL AMOUNT DUE AND PAYABLE((adU lines 9,10, mind 1 T) t2. S <br /> I hereby centty that iris datum,including"accomparying 60hoOOBS and statements.I=been <br /> examined by me and to this bem of my knoMadgs and boW is a true,Correct and complete return. <br /> ON771,F72�'Aw <br /> e ; �f d` b?o btoz �_ <br />