Form BOE-501-FFP Fillable Hazardous Waste Facility Fee Prepayment Form - Federal First Prepayment
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(a)Postclosure permit small facility Manages 0 5 tons (1 000 pounds) or less of hazardous waste (b)Postclosure permit medium facility Manages more than 0 5 (1 000 pounds) but less than 1 000 (c)Postclosure permit large facility Manages 1 000 or more tons of hazardous waste during any (DTSC) to establish capacity and/or type If a facility's allowable capacity changes or is initially established as the result of certification or permit (Sm Qty ) [ FOID ] YOUR ACCOUNT NO 1 000 tons of hazardous waste 1 500 gallons per calendar month or total volume of solid hazardous waste treated is less than 3 000 1 Disposal facility (if you are a government agency please see instructions on reverse) 1 $ $ 10 Postclosure permit facility within the first five years of the 10(a) SMALL 10(b) MEDIUM 10(c) LARGE 100 000 pounds per calendar month or any liquid or solid hazardous waste is stored for more than one 11 Postclosure permit facility beyond the first five years of the 11(a) SMALL 11(b) MEDIUM 11(c) LARGE 12 Calculate prepayment due (must not be less than 50% (0 50) of the highest permitted fee category) 12 $ 13 Penalty [multiply line 12 by 10% (0 10) if payment is made after due date shown above] PENALTY 13 $ 14 Interest does not apply to this program INTEREST 14 15 TOTAL AMOUNT DUE AND PAYABLE (add lines 12 and 13) 15 $ 2 Large onsite treatment facility 2 3 Large offsite treatment facility 3 4 Small treatment facility 4 5 Minitreatment facility 5 50 percent (0 50) of the applicable fee See "Return Preparation" below An annual return will be due and payable on the last day of February 6 Large storage facility 6 7 Small storage facility 7 8 Ministorage facility 8 9 Standardized permit facility (enter fee for appropriate category) 9(a) SERIES A 9(b) SERIES B 9(c) SERIES C 9(d) SERIES C 94279 0088 You may also visit the BOE website at www boe ca gov or call the Taxpayer Information Section at 1 800 400 7115 (TTY:711); A facility fee is due from the facility operator for a facility that has been issued a postclosure permit The fee is due based upon the Always write your account number on your check or money order Make a copy of this document for your records AMOUNT OF an adjusted annual rate established under section 6591 5 of the Revenue and Taxation Code and type of facility as specified in the permit Interim Status Document (ISD) or Federal Part A Application If your facility qualifies for more than ANNUAL applicable rate in column B for the proper fee category applicable rate in the column B for the proper fee category BEFORE PREPARING BOARD OF EQUALIZATION BOE 501 FFP (S1B) REV 13 (4 13) BOE 501 FFP (S1F) REV 13 (4 13) STATE OF CALIFORNIA BOE 501 FFP (S2) REV 13 (4 13) BOE USE ONLY but less than 500 000 gallons liquid hazardous waste or greater than 100 000 pounds but less than 500 calendar year category until you have been approved by DTSC to operate according to a standardized permit Otherwise you should report under CLASSIFICATION OF FACILITY SITES CLEAR PRINT close DEFINITIONS FOR HAZARDOUS WASTE FACILITY FEE PREPAYMENT FORM FEDERAL Disposal facility A facility used for the disposal of hazardous waste due date falls on a Saturday Sunday or legal holiday returns postmarked on the next business day are considered timely DUE ON OR BEFORE during any one month of the current fee period and submit a certification or permit modification to the Department of Toxic Substances Control during any one month of the reporting period effective EMAIL ADDRESS Enter in column B the rate for the highest category at which your facility is permitted for the current calendar year If you are a Equalization Under section 43155 of the Hazardous Substances Tax Law late payment will result in a 10 percent (0 10) penalty and interest at examined by me and to the best of my knowledge and belief is true correct and complete exceed 10 000 pounds per calendar month exceed 5 000 gallons per calendar month or total volume of solid hazardous waste treated does not FACILITIES THAT CEASE TO OPERATEFacilities engaged in treatment and storage owe the highest fee to which the facility has ever been subject for the reporting period immediately FEDERAL LIABILITY FOR THE FEE FEE DUE FEE RATE FILING REQUIREMENTS OF SCHEDULE FIRST PREPAYMENT following the current year Fee returns and payments that are mailed must be postmarked on or before the due date shown on the return If the following the period during which the facility ceased actively treating or storing waste Disposal facility must pay two times the fee for the from the main menu select the option Special Taxes and Fees gallons of liquid hazardous waste or greater than 500 tons of solid hazardous waste or any liquid or solid GENERAL government agency operating a disposal facility which did not dispose of hazardous waste during the reporting period enter $10 000 HAZARDOUS WASTE FACILITY FEE PREPAYMENT FORM FEDERAL BOARD OF EQUALIZATION HAZARDOUS WASTE FACILITY FEE PREPAYMENT FORMFEDERAL INSTRUCTIONS hazardous waste is stored for more than one calendar year hazardous waste or less than 30 000 pounds solid hazardous waste highest rate I hereby certify that this form including any accompanying schedules and statements has been identified in lines 1 through 11 If you need additional information please contact the State Board of Equalization Special Taxes and Fees P O Box 942879 Sacramento CA If your permit ISD or Federal Part A does not state the facility capacity and/or type report at the highest level at which the facility operated in column B for line 1 only interest imposed by the California Revenue and Taxation Code January 1 1994 you will be deemed to have ceased activity when you have actually ceased the activity and notified DTSC of your intent to Large onsite/offsite treatment facility Treats land treats or recycles 1 000 or more tons of hazardous Large storage facility Stores 1 000 or more tons of hazardous waste Line 10 If the reporting period is within the first five years of the postclosure period select the appropriate facility size and enter the Line 11 If the reporting period is beyond the first five years of the postclosure period select the appropriate facility size and enter the Line 12 Enter the amount of prepayment being paid The amount must not be less than 50 percent (0 50) of the applicable fee due as Line 13 If your fee return is postmarked after the last day of February of the current year a penalty is due The penalty is 10 percent (0 10) of Line 15 Add lines 12 and 13 Line 9 Enter the applicable fee in column B if you are operating under a standardized permit Please note that you cannot report in this Lines 10and 11 Lines 1thru 8 liquid hazardous waste or less than 100 000 pounds solid hazardous waste Make check or money order payable to State Board of Equalization management of hazardous waste including the payment of the Hazardous Waste Facility Fees However the Federal Government is not liable for Ministorage facility Stores 0 5 tons (1 000 pounds) or less of hazardous waste Minitreatment facility Treats land treats or recycles 0 5 tons (1 000 pounds) or less of hazardous waste modification the fee that is due for the fee period in which the change occurs is the higher fee If a facility's type changes as the result of a Offsite facility A hazardous waste treatment facility that is not an onsite facility one category (full permit standardized permit or postclosure permit) during the fee period the amount due is the fee for the category with the one month of the reporting period Onsite facility A hazardous waste treatment facility at which hazardous waste is produced andwhich is owned by leased to or under the control of the producer of the waste Payments: You can make your payment by paper check Online ACH Debit (ePay) or by credit card To use ePay go to our permit or ISD modification any change in the facility fee will be effective the fee period following the one in which the modification becomes PO BOX 942879 postclosure period (enter fee for appropriate category) pounds per calendar month Prepayments of the fee are due and payable by the last day of February and August of the current year The prepayments must not be less than prepayments on or before the last day of February and August of the calendar year with a remittance payable to the State Board of RA B/A AUD REG READ INSTRUCTIONS reporting period immediately following the period during which the facility ceased disposal activity If your facility ceased activity on or after RETURN PREPARATION RR QS FILE REF SACRAMENTO CA 94279 6015 Series A Standardized Permit (Storage) Total facility storage design capacity is greater than 500 000 Series A Standardized Permit (Treatment) Line 9 Total influent volume of liquid hazardous waste treated is greater Series B Standardized Permit (Storage) Total facility storage design capacity is greater than 50 000 gallons Series B Standardized Permit (Treatment) Total influent volume of liquid hazardous waste treated is greater Series C Small Quantity (Storage) Total facility storage design capacity is less than 15 000 gallons liquid Series C Small Quantity (Treatment) Total influent volume of liquid hazardous waste treated is less than Series C Standardized Permit (Storage) Total facility storage design capacity is less than 50 000 gallons Series C Standardized Permit (Treatment) Total influent volume of liquid hazardous waste treated does not SIGNATURE PRINT NAME AND TITLE TELEPHONE size of the facility Definitions of facility sizes are attached Small storage facility Stores more than 0 5 tons (1 000 pounds) but less than 1 000 tons of hazardous Small treatment facility Treats land treats or recycles more than 0 5 tons (1 000 pounds) but less than SPECIAL TAXES Aa ND FEES STATE OF CALIFORNIABOARD OF EQUALIZATION than 5 000 gallons but less than 50 000 gallons per calendar month or total volume of solid hazardous than 50 000 gallons per calendar month or total volume of solid hazardous waste treated is greater than The annual Hazardous Waste Facility Fee is imposed according to Health and Safety Code section 25205 2 based upon the allowable capacity the appropriate facility category listed on lines 1 through 8 the fee due on line 12 The following definitions apply to the facility's allowable capacity during any one month as stated in yourpermit ISD or Federal Part A If no capacity is stated you must report based on your actual operations tons of hazardous waste during any one month of the reporting period tons solid hazardous waste Under 42 U S C section 6961 federal departments instrumentalities and agencies are subject to state regulation concerning disposal or Under section 43152 12(a) of the Hazardous Substances Tax Law every facility operator who owes the facility fee is required to file two waste waste treated is greater than 10 000 pounds but less than 100 000 pounds per calendar month website at www boe ca gov click on the eServices tab and log in to make a payment To pay by credit card go to our website or call 1 855 292 8931 Mandatory EFT accounts must pay by EFT or ePay Be sure to sign and mail your return