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a STATE OF P.O. BOX 647-- BOARD OF EQUALIZATION <br /> �P CALIFORNIA SACRAMENTO, CA 95803-0647 HAZARDOUS WASTE CONTROL ACCOUNT <br /> r> <br /> HAZARDOUS WASTE TAX RETURN t (FEE) / <br /> 'ul DUE ON OR BEFORE 01 /31 /90FOR OCT - DEC 89 <br /> Mail to: 03679 39002 f 4989 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 <br /> READ INSTRUCTIONS Make Changes Above if PM REC REC <br /> BEFORE PREPARING CAT0006461 82 Name or Address Ineorrect N0. <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. 8 x C) <br /> Recycle Excludes used oil removed from a motor 0 a <br /> Da. vehicle and subsequently recycled) :� ayQ � 's � ,��. <br /> Ob. Out of State 5 .2 6 1 18.38 110 . 28 <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 /> 5a 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) $ 110 . 28 <br /> 10. Penalty of 10% CIO) if payment is made after the due date shown above. Penalty 0 <br /> Interest 0 <br /> 11. IS DUE IF MADE AFTER THE DUE DATE. <br /> 12- TOTAL AMOUNT DUE AND PAYABLE -- - - - - - - - - - -- - - - (Add lines 9. 10 and 11 ) s 110 . 28 <br /> 1 hereby certify that this return, including any accompanying schedules and statements. has been <br /> examined by me and to the best of my know)ed a and bel f is a true, correct, and complete return. <br /> .�/W.dz1 _ - � 'y/{J' ����,'Qxp'� - - - - Nom-_ __Z_a�4?9 i%%� -- --�-z <br /> Prim yPc Name and Title / / Sign re Phooe Number Dale <br /> MAKE CHECK OR MONEY ORDER PA BLE STATE BOARD OF EQUALIZATION <br /> Always Wrim Your Account Number on Yuur Check or Money Order MAKE A COPY FOR YOUR RECORDS <br />