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SP EDULE.a--FU$SUMMARY SHEET(3006 manifests) (See back of lli(.Tform`forcomprelo1r?'-uct(oFs.) SrCTI.QN A &FA.tD.NUMBER VERIFiGATiON FEE(July 1,X01)8-June:30,2009) 1. .Name dfyour.orgenlzCtion: (Required) 7iDrY.�r An pl;ca 4 )j1+ .1i,n /fit .. r i0cr 2. Fedorel E5+nployer IdenlfOcation.tVumber FEIN; Ra tjitid • "Ti ix ) I. q - )..�1A..-12��I Ct_: • (gtSo calldcl b Fedorpl Tpx lD.) If ygli do nbt Iiave a Feddrol:Employer-ID Kumber,.please provide your-Social .. unity Number. 3, Enter ttw total number of persons employed by.youf organizatiorl"In.Callfornlo: _21 „(See rgversd j NuEPAjD,Fee Rate tEm to aes 4-49 00-74 7b-_99, 100 4-0 -260-498 ¢OQorinore !Pq IONO FEE 150 _ _ 176 200, 5226 $250 (Total.El?A D' UmhojV. ytficatlon F009 not.to exceed$0000) Q: Ehlerrthe EFA LD Npinbe(Vsr)tIdatlon Fee[ate from the to le above. g _ 5. Enter Tho-total number of permanent EPA ID Numbers held by your organization and active at anY lime -during July 1,2008-June 30.'2009. Attac)l-a Vorincallon Qlrostlonnalro'(page 1)and Schedule A for r oath pormanencEPA IO;NU+i,4er. EkOddb numbers begrnning with`CAG'or*('AP•. ti: Mullfpfy the$.Awounlln A.d:by the.number In.AA $—� 7,, TOTAL FPA 10 NUf4.BERYERIFiCg7tON FEEpU6. (Etitsrlhe dolfarambunl frgirY l;foa.AG: Wive OR$6000,wbidrevor amount is.less) S,EGTIM B - MANIFEST FEF_-(January-!,26d8;-becember.d'l,2008) 1. Frttet Ihe,eoliar amount op.!(pe e.+irom your Schedule A.�ManilestFee.CaICulallon Sheol. If.you are. ' reporting more-1han ono ID-Numbar,onter.tha'TOTAL of th�dgllor bm0pnw in Line e.frojn kIt ofygUr Schoduio.A-Manifest Fee Calculalion'Sheeis. 2. CafefUlly rap(l the I+isku000ns11sted or ihe1ack-tri$ecttan 8-1 beforo completing tills section. liytlur bub)na44 has lo: 'then 1.00 etnploY9es;thg first four non•recycled manifests used In the 2008 calendar year aro free. (Manlfosis usQdsolgjy:for hazardous wasto derived from air,eomplIance solyerilsaro exciUded.arid,Cannot he clolmed as free:), m to t- )n:Arder to Y0401Vo-thb credit,.you must list tho manifestitumbor(s)for each of,tho non- cyc ej red manl(ost(e)you aro�claimin0 as free. Please check your tecords for miililfost numbers. If you d4 not bave e copy o(yourmanifeat(s),contact your hazardous-was to' transporter. -0049.4 3. Enter-tile numberof non•rpcyclod rjienJfe$Is GJotnied tree. If none,WaVe bl'anh. X$7.5o,Cr6ol.c. $ q� 4: MANIFEST FEE DUE FOR 200.8 MANIFESTS(Subtract$In Llne 13.3.from Line B,t.) SECTION C - GRAND.TtjTAL QF EPA i- NU INP E.R.VERIFICATION FEES A.Ni).MANtFEST F"S Ad.dliie$amount in A.7 and the$amount B.4. Enter fhe total: TOTAL-FEE DUE: i It yeo do not'oyvo any fees;.yOu.AresfffEre,qulrerl to.compfefe and subrriIta!!/orT»s, If pgMg by Chock,make Check payable to DTSCB ivfi Ione of v0ur EPA ID Numbers on ygur clLpd. If you ore ppyinfj by cred(t tard,.use th'g enciosoid credll'cord(Orin. f h0rQ6y cortlfy udder p6Nd!(y Of porfury fhg!the lnfojmaftorr pn;Scjiedute A(sJ and:Schedu/e 8.1s,true grid correct. I S)gnalurq o!Preparer• ��}� _ 71t1e: Mt_ �y,�,�,1 'I Nemo(please print):_--t;-1 "u�t�t Dale•'7-A-C phbhe�1 1 Qa�1 aZ PLEASE RETURN T H.99131G NAL_OF THE FOLLOWINQ-DOCUME*TS•WITHIN:90-DAY$ --•--------- Veri lion Quostioniieira (01116"'Wificpllon Qu6sllonnalre for each EPA IO Number) Schedule A.—MenlrostFee Caieulelldn sheet (one ScheduloA for each EPA ID-Number) I Schedule B-Feo Summary Shee'l (only ono Schedule B Is needed for your entire organization) P.aymOnl Duo,If any. i THIS LECTION FOR DEPARTMENT.USE ONLY Chock No: $AMOUNT DATE: CID NO. 12500055: '12680082: 126600e5: 12560035: T26600)1: AMOUNT DUE: 12660076: 12500006: PRIMARY ID U: bTSC 1104B-(FRONT)(4/09)