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E-501-HWD FRONT REV. 311-931 P.O_BO::942754 STATE OF CALIFORNIA <br /> SACRAL ,A 94291-2754 BOARD OF EQUALIZATION <br /> %i --%.00 (916)323-9555 <br /> HAZARDOUS WASTE DISPOSAL FEE RETURN BOARD USE ONLY <br /> REG RR PR <br /> DUE ON OR BEFORE 04/30/93 FOR JANUARY - MARCH 19{ lIyIRR16P1ENTAL <br /> C AUD NR <br /> Account umoer t <br /> Mail To: HWCA RVHW02 1393 HA HQ 36-006312 1 REF DD pi <br /> STATE BOARD OF EQUALIZATION = 111 <br /> ENVIRONMENTAL FEES DIVISION I NDY ELECTRONICS INC. FILE <br /> PO BOX 942754 P. 0. BOX 2301 PM <br /> SACRAMENTO CA 94291-2754 MANTECA CA 95336 <br /> READ INSTRUCTIONS <br /> BEFORE PREPARING <br /> CAT000646182 Make changes d name <br /> 400 INDUSTRIAL PARK DRIVE, MANTECA or address is incorrect <br /> A B c D <br /> TOTAL TONNAGE TAXABLE TONNAGE FEE RATE AMOUNT <br /> CATEGORIES DISPOSED OF <br /> (Definitions enclosed) (Round up to OF FEE <br /> - - BY CATEGORY -- Whiffle Wn.) (pot.B x C <br /> I <br /> 1. Recycled (excludes used oil removed from a motor 1. <br /> vehicle) 5 0.00 <br /> 2, Non-RCRA regulated hazardous waste (generally 2. <br /> includes asbestos) 26.�5 <br /> 3. Mining waste 3. <br /> 13.65 <br /> 4. Extremely hazardous waste 4_ <br /> 2.10.00 <br /> 5. Restricted waste 5. 2°10.00 <br /> 6. Hazardous waste 6. <br /> 42.42 <br /> 7. Transported out of state 7. 3 0.00 <br /> 8. Residues from incineration or dechlorination 8. <br /> of hazardous waste 5.25 <br /> 9. Total fee (add lines 1 through B in Column D) g 0 <br /> 10.Penalty [multiply line 9 by 10% (.10)if payment is made after due date indicated above] PENALTY 10. <br /> 1t. INTEREST OF 11% PER ANNUM (0.009167 PER MONTH) INTEREST 11. <br /> 12.TOTAL AMOUNT DUE AND PAYABLE (add lines 9,10. and 11) 12. g <br /> I hereby certify that this return,including any accompanying schedules and statements, has been <br /> examined by me and to the best of my knowledge and belief is a true. correct and complete return. <br /> PHIN FnTPI:NAME AND I I I LE 61UNAIUFUZ PHONE NUMBER DATE <br /> William L. Price, Safety/Envir. Spec. (20 ) <br /> Always write your account number on your check or money order. Make a copy for your records. <br />