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10:3,1%95 C11B:29 LOF GLASS LATHROP ppb <br /> BP$V1.41N/D(61F)REV.a(3.94! P.D.80648T64 UWE OF C�ALIADFINA <br /> sAc o CA 94291.2764 • BOARD OF EOUALIZATION <br /> f9/W 323.9656 <br /> HAZARDOUS WASTE DISPOSAL FEE RETURN sOA-USE ONLY <br /> Pit <br /> RUE ON OR BEFORE 7/31/94 FOR APRIL - JUNE, 1994 <br /> TR AUD NR <br /> m u <br /> Mail T0; HWCA FIVHWD$ 2494 HA HQ 36-009011 1 ao w <br /> STATE BOARD OF EQUALIZATION <br /> ENVIRONMENTAL FEES DIVISION i RISK MGMT-ENVIRONMENTAL AFFAIRS FILL <br /> PO BOX 942754 LIBBEY-OWENS-FORD COMPANY <br /> SACRAMENTO CA 94291-2764 ATTEN_ JON WEISS <br /> 500 E.LOUISE AVE PLANT 1 READ tNSTpl1CT16NS <br /> LAT14ROP - CA 95330 BEFORE PREPARING <br /> 500 E.LOUISE AVE PLANT 7 , LATHROP Make onarga n norm <br /> CA D005415633 or o6*esa m IwwrTaut. <br /> CA7EDORIebA 5 C D <br /> (Daunfhi enalordl TWAL To"I4AO6 TA%AOLV TO9a4AME PEE"ATC AMOUNT <br /> DIGPOSED OF (Roune up to or FEL. <br /> eY CA MOORY whare Ion) 18olumn e x Ct <br /> 1. Recycled(e)cludes used til remove from D 1710fir 1. <br /> vehicle <br /> 24. Nort-RCRA regulated hazardous watts(Ounorafly 2a. .•� "�'.'r: ::;;`�' n � <br /> braludes asbastC9) a, aJ' ' '1 :* y=: •T g �' <br /> 20.Non-RCRA regulated hazardous waste perwam 2b. Room <br /> in a Cleanup action(exmuon ub"tas) -act' <br /> 3. Mininp waste s. ;; M <br /> q. Extremely hatar'douS weals 4. - <br /> - C® <br /> S. SoWuted wasid - .. e <br /> 0. Hazardous waste 6. ( <br /> X9. 5 a+� " :=: I�lS I0 <br /> 7. Transported out of State - <br /> I <br /> 8. Residues from Incineration or doohlo6naticn 0• <br /> of hazardous waste 5.25 <br /> 8. Total fee (add linea 7 through 8 in C.xf#mn R) 9• I;59 r <br /> 10- (malty (multiply line 9 Ay 1072,(.70)%payment is made alter due dale indr'cated above) PENALTY 10. <br /> 11, INTEREST OF 1D% PER *NNUM (D.008333 PER MONTH) INTEREST it. <br /> IS DUE IF PAYMENT IS !MADE AFTER THE DUE DATE. <br /> 12,TOTAL AMOUNT DUE AND PAYABLE:'(atfd/ares 0,10,and f f) 42, $* 51 <br /> I hereby ca ft that tins rearm,m(dutfing any ancompanyrng achodulas and 6tataanenlo•tae teen <br /> WOMIAW by rna and to PID best DI my knowiaopv a,rd OMka)is a UW.correct and complea,return. <br /> Un KMMUNEYMUERPAVAULL <br /> Al"VS vAtto year act gnt mnnter or,your check or men®y order. Make a copy for your records, <br />