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STATE OF P.O. BOX 647 BOARD OF EQUALIZATION <br /> CALIFORNIA SACRAMENTO, CA 95803-0647 HAZARDOUS WASTE CONTROL ACCOUNT <br /> HAZARDOUS WASTE TAX RETURN (FEE) <br /> DUE ON OR BEFORE 10/31/89 FOR JUL - SEP 89 <br /> Mail to: 03679 39002 3989 I HA HQ 36-006312 <br /> STATE BOARD OF EQUALIZATION <br /> EXCISE TAX DIVISION <br /> P.O. BOX 647 <br /> SACRAMENTO, CA 95803-0647 INDY ELECTRONICS INC. <br /> P.O.BOX 2301 <br /> MANTECA CA 95336 REC <br /> READ INSTRUCTIONS Make Changes Above If PM REC NO. <br /> BEFORE PREPARING CATo00646182 Name or Address Incorrect <br /> A B C D <br /> Categories Total Tonnage Taxable Tonnage <br /> (Definitions Enclosed) Disposed of (round up to Rate of Tax Amount of Tax <br /> By Category whole ton) (Col. B x C) <br /> Recycled Excludes used oil removed from a motor 3 <br /> Oa. vehicle and subsequently recycled) 2 . 3 <br /> ,`P • ,;N`r <br /> Co. Out of State 18.38 <br /> Non-RCRA Regulated (Generally includes asbestos. <br /> 1. petroleum based waste and hazardous shredder waste) 13: 13 <br /> 2. Mining Wastes 13. 13 <br /> 3a. Extremely Hazardous Surface Impounded 105.00 <br /> 3b. Extremely Hazardous Not Surface Impounded 105.00 <br /> 4a. Restricted Wastes Surface Impounded 105.00 <br /> 4b. Restricted Wastes Not Surface Impounded 105.00 <br /> Ea Other. (See category definitions) 2.63 <br /> 5b. Other. (See category definitions) 2.63 <br /> Hazardous Waste Landfilled (Generally excludes <br /> 6a. asbestos and petroleum based waste - See line 1) 52.50 <br /> 6b. Hazardous Waste Landfarmed 52.50 <br /> 6c. Hazardous Waste Injection Well 52,50 <br /> 6d. Hazardous Waste Surface Impounded 52.50 <br /> Double Lined Surface Impoundment Restricted Cat- <br /> 8. egory - See category definitions) 5.25 <br /> 9. Total Tax (add column D lines Ob through 8) S -0- <br /> 10. Penalty of 10% (.10) if payment is made after the due date shown above. Penalty <br /> INTERLSI OF 14% FLR ANNUM b Interest <br /> it. IS DUE IF MADE AFTER THE DUE DATE . <br /> 12. TOTAL AMOUNT DUE AND PAYABLE __ _ _ _ _ _ _ _ _ _ __ _ _ _ (Add lines 9, 10 and 11 ) S -0- <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 /> �f1RY /y1' 1�9v/S SAFEry/EN_✓_/- - - - - - /l�vr. C ' _�2O�z35-YYYy Co�1 �1 <br /> Print/Type Name and Title y Phone Number Date <br /> MAKE CHECK OR MONEY ORDER PAYABLE TO STATE BOARD OF QUALIZATION <br /> Always Write Your Account Number on Your CI¢cL or Wney Order MAKE A COPY FOR YOUR RECORDS <br />