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-50"OWD FRONT REV. 3 (1-93) P.0 BO' ' -;4 STATE OF CALIFORNIA <br /> SACRA` CA 94291-275° HOARD OF EQUALIZATION <br /> L <br /> 1916)323.9555 <br /> HAZARDOUS WASTE DISPOSAL FEE RETURN f P t�1E A NLY <br /> R PA <br /> DUE ON OR 6E=-ORE 07/31/93 FOR APRIL - JUNE 1993 - � , _ C <br /> AC=Unl N 1001 A y i ''I NR <br /> Mai; To: HWCA RVHW02 2393 HA HQ 36-006312 4 RIEiI=l 100 • <br /> STF-.T= BOARD OF EQUALIZATION <br /> ENVIRONMENTAL FEES DIVISION INDY ELECTRONICS INC. FILE <br /> PO E0X 942754 P. 0. BOX 2301 Pia <br /> SACRAMENTO CA 94291-2754 MANTECA CA 95336 <br /> READ INSTRUCTIONS <br /> BEFORE PREPARING <br /> CAT000646182 Make changes if name <br /> 400 INDUSTRIAL PARK DRIVE , MANTE CA or adoress is incorrect. <br /> A B c D <br /> TOTAL TONNAGE TAXABLE TONNAGE FEE RATE I AMOUNT <br /> CATEGORIES DISPOSED OF <br /> - (Definitions enclosed) I I (Round up to OF FEE <br /> BY CATEGORY j wnoie ton., Icol. B x O) <br /> 1. Recycled (excludes used oil removed from a motor 1. D.00 <br /> ventole) <br /> 2 0 S O <br /> ! 2, ;4cn-RCP.A regulated hazardcus waste(generally 2. <br /> inculdes asdestos) I 26.25 <br /> i <br /> i <br /> I <br /> a-mining waste 3. i <br /> 13.0$ <br /> I <br /> 4. Exrreme!y hazardous waste 4. <br /> 210.00 <br /> 5. Restricted waste 5. I 210.00 <br /> i <br /> S. Hazardous waste B. <br /> 42.42 <br /> I I <br /> 7. Transported out of state T. 0.00 <br /> B. Residues from incineration or dechlorination 8- <br /> 0 <br /> . <br /> of hazardous waste 5.25 - <br /> 9. Total fee (add lines 1 through 8 in Column D) 9. 0 <br /> 10.Penalty (multiply line 9 by 10% (.10)if payment Is made after due date indicated above,) PENALTY 10• <br /> !t. INTEREST OF 10% PER ANNUM (0.008333 PER MONTH) INTEREST 11. <br /> InIIF I c PAYMFMT ilz marip ACTPP TWC <br /> 12.TOTAL AMOUNT DUE AND PAYABLE (add lines 9.10. and 11) 12.IS 0 <br /> I nereby eervfy That Nis rerum.including any accompatirng scheoules and Statements. nes Deen <br /> examined by me and to the oest of my knowledge and belief is a true. correct and complete return. <br /> William L. Price, Safety/Environmental Spec.��lyN� x,�� (209) 825-8314 7/30/93 <br />