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ti BOARD OF EQUALIZATION
<br />,31 a Rev a ; -3; i S BOX
<br />60 CA 95803-0647 EXCISE TAX UNIT
<br />STATE OF CALIFORNIA
<br />HAZARDOUS WASTE DISPOSAL REPORT - ANNUAL `SUPERFUND' TAX
<br />DUE ON OR BEFORE M A ;'C Ill I v I° 8 ",
<br />Mail to:
<br />BOARD OF EQUALIZATION
<br />EXCISE TAX UNIT
<br />P.O. BOX 647
<br />SACRAMENTO, CA 95803-0647
<br />F4i� CAtHblKit YEAq 1 8
<br />HS HQ 36-018313
<br />-ARN4TI04 CO CAN DIV.
<br />P.0.3GX 270
<br />STOCKTON CA 552.11
<br />IT -AS SITE: 1°1_; N10/y R STOCKION
<br />This report must be filed on or before the due date shown above by every person who submitted for disposal off-site, or who disposed of on-site,
<br />hazardous waste or extremely hazardous waste in California during the above calendar year. Do not include wastes that are recycled or transported
<br />out of state for disposal. Any fraction of a ton must be rounded up to the next whole ton. Any person disposing of 500 pounds or less during the above
<br />calendar year must report zero tonnage. ANY PERSON WHO KNOWINGLY REFUSES TO FILE THIS REPORT AS REQUIRED SHALL BE
<br />LIABLE, UPON CONVICTION, FOR A CIVIL PENALTY PURSUANT TO SECTION 43602 OF THE HAZARDOUS SUBSTANCES TAX LAW.
<br />"HAZARDOUS WATE" means a waste, or combination of wastes, which because of its quantity, concentration, or physical, chemical, or infectious
<br />characteristics may either:
<br />a. Cause, or significantly contribute to an increase in mortality or an increase in serious irreversible, or incapacitating reversible, illness.
<br />b. Pose a substantial present or potential hazard to human health or environment when improperly treated, stored, transported, or disposed of, or
<br />otherwise managed.
<br />"EXTREMELY HAZARDOUS" means any hazardous waste or mixture of hazardous wastes which, if human exposure should occur, may likely
<br />result in death, disabling personal injury or serious illness caused by the hazardous waste or mixture of hazardous wastes because of its quantity,
<br />concentration, or chemical characteristics.
<br />I hereby certify that this report, including any accompanying schedule and statement, has
<br />been examined by me and to the best of my knowledge and belief is true, correct and complete.
<br />E. D. STETSON/Manager �' 209 11 466-1031 2-22-88
<br />SIGNATURE AND ITL
<br />TE PHONE NUMBER DATE
<br />If you have any questions regarding this report, please contact the
<br />State Board of Equalization, Excise Tax Unit, Phone (916) 322-9070
<br />HAZARDOUS WASTE CATEGORIES
<br />TOTAL TONS
<br />A.
<br />The total tons of HAZARDOUS waste, the Federal Regulation of which has been suspended under the Solid
<br />Waste Disposal Act by Act of Congress, disposed of, or submitted for disposal, in California, plus the total tons
<br />of waste material transferred to a surface impoundment in California for the purpose of reducing water content
<br />—D—
<br />of such waste and material by evaporation, plus the total tons of hazardous waste disposed of into an injection
<br />well or landfarm, exclusive of the waste reported in Categories D and E.
<br />NOTE: LAND FILL DISPOSAL IS NOT LAND FARMING.
<br />B.
<br />The total tons of HAZARDOUS waste disposed of, or submitted for disposal, in California exclusive of the
<br />waste reported in Categories A, C, D, and E.
<br />36
<br />NOTE: LAND FILL ONLY.
<br />C.
<br />The total tons of EXTREMELY HAZARDOUS waste disposed of, or submitted for disposal, in California
<br />exclusive of the waste reported in Categories A, B. D, and E.
<br />—0—
<br />NOTE: LAND FILL ONLY.
<br />D.
<br />The total tons of HAZARDOUS waste disposed of, or submitted for disposal, in California from the extraction,
<br />beneficiation and processing of ores or minerals including phosphate rock and overburden from mining or
<br />—0—
<br />uranium ore.
<br />E.
<br />The total tons of HAZARDOUS waste disposed of, or submitted for disposal, in California that is a solid
<br />—0—
<br />hazardous waste residue resulting from incineration.
<br />I hereby certify that this report, including any accompanying schedule and statement, has
<br />been examined by me and to the best of my knowledge and belief is true, correct and complete.
<br />E. D. STETSON/Manager �' 209 11 466-1031 2-22-88
<br />SIGNATURE AND ITL
<br />TE PHONE NUMBER DATE
<br />If you have any questions regarding this report, please contact the
<br />State Board of Equalization, Excise Tax Unit, Phone (916) 322-9070
<br />
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