Laserfiche WebLink
W7-501-HWD FRONT REV,3 11-93) P.O. '54 STATE OF CALIFORNIA <br /> SACR.~.."?1TG,CA 94291-2154 �`� BOARD OF EQUALIZATION <br /> (916)323-9555 <br /> HAZARDOUS WASTE DISPOSAL FEE RETUR '1,,,-, ,.; F BOARD USE ONLY <br /> DUE ON OR BEFORE 0131/94 FOR OCTOBER - DFLEMt_ER 11` 993 RCS RR PR <br /> TR ALM) NR <br /> Mail To: HWCA RVHW02 4393 1 HA�HQ 36-00631 - REF Go PI <br /> STATE BOARD OF EQUALIZATION <br /> ENVIRONMENTAL FEES DIVISION I NDY ELECTRONICS INC. FILE <br /> PO BOX 942754 P. 0. BOX 2301 <br /> PM <br /> SACRAMENTO CA 94291-2754 MANTECA CA 95336 <br /> READ INSTRUCTIONS <br /> CAT000646 1 82 BEFORE PREPARING <br /> 400 INDUSTRIAL PARK DRIVE MANTECA or <br /> addresschange <br /> amine <br /> w address is incorrect. <br /> A B C D <br /> CATEGORIES TOTAL TONNAGE TAXABLE TONNAGE FEE RATE AMOUNT <br /> MO flnft!VTM annlozedi WSPOSED OF (Round up to OF FEE <br /> BY CATEGORY whole ton.) <br /> (coll.B z CI <br /> 1. Recycled (excludes used oil removed from a motor 1. x s. •! <br /> vehicle) 000' <br /> 4 !" <br /> 2, Non-RCRA regulated hazardous waste (generally 2. - - <br /> includes asbestos) 2b 2$ <br /> a. Mining wane 3. <br /> 4. Extremely ha2ardous waste 4 w <br /> 21n.oa3 <br /> 5. Restricted waste 5. 210 001, <br /> 77 <br /> 6. Hazardous waste 6 <br /> = 42.42:::: <br /> 7. Transported out of state 7. <br /> 8. Residues from incineration or dechlorination 8. <br /> ofhazardous waste .. ..,` <br /> 5 23: <br /> 9. Total fee (add lines 1 through 8 in Column D) 9. <br /> 0 <br /> 10.Penalty (mutjply line 9 by 1055 (.10)if payment is made after due date indicated above) I PENALTY 10. <br /> 11. INTEREST OF 10% PER ANNUM (0.008333 PER MONTH) INTEREST 11. <br /> IS Q'Ir F <br /> 12.TOTAL AMOUNT DUE AND PAYABLE (add lines 9.10, and 11) 12 $ 0 <br /> 1 hereby certify that this return.including any aecomparlyirg schedules and statements,has been <br /> examined by me and to the best of my imowiedge and belief is atr/true, correct and complete retum. <br /> William L. Price Safety/Environmental Sp. �yyt A 49�_ 209) 825 8314 1118/94 <br /> 47�Fi[7Z'7E-1 F''44aa larn�-r�__re <br />