California Code of Regulations › Title 27 - Environmental Protection › Division 1 - General Functions and Responsibilities › Subdivision 4 - State Delegation › Chapter 1 - Unified Hazardous Waste and Hazardous Materials Management Regulatory Program › Part II - Operations › Article 10 - Business Reporting to CUPAs › Appendix C - Reports and Forms

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
SURCHARGE TRANSMITTAL
									 REPORT
27 CCR §§
																		15250 and
									 15290
CUPA:
Date Submitted:
Fiscal Year of Accrued
								  Surcharges:
Fiscal Quarter of Accrued Surcharges:
Check Number:
Completed By:
Telephone Number:
Program Element
Amount Remitted
CUPA OVERSIGHT
ABOVEGROUND PETROLEUM STORAGE ACT
								  (APSA)
UNDERGROUND STORAGE TANK PROGRAM
CALIFORNIA ACCIDENTAL RELEASE
								  PREVENTION PROGRAM (CalARP PROGRAM)
REFINERY SAFETY
TOTAL
This Surcharge Transmittal Report, a
								  copy thereof, or a substantially equivalent report shall be completed and
								  submitted to the Secretary no later than 30 days after the end of each state
								  fiscal quarter as specified in CCR, title 27, §
															15290(b).
Please staple the remittance check to
								  this Surcharge Transmittal Report as a cover document each time surcharge
								  revenues are remitted.
Please make remittance payable
								  to the
Secretary for Environmental Protection.
The Surcharge Transmittal Report and
								  remittance can be submitted to CalEPA, care of the Air Resources Board,
								  at:
Air Resources Board
Attn:
								  Accounting
P.O. Box 1436
Sacramento, California 95812
An electronic copy of this
								  Surcharge Transmittal Report must also be sent to: [email
								  protected].
For questions, please contact
								  the Unified Program at [email protected].
ANNUAL SINGLE FEE SUMMARY
								  REPORT
27 CCR §§
																	15240 and
								  15290
CUPA:
__________
Fiscal
								  Year:
__________
Completed
								  By:
__________
Date
								  Submitted
__________
Telephone Number:
__________
SINGLE FEE
Total amount of single fee
								  billed
Total amount of single fee waived
Total amount of single
								  fee collected
__________
__________
__________
PARTICIPATING AGENCIES
Amount of single
								  fee billed for PAs
Total amount of single fee collected for
								  PAs
Total amount of single fee remitted for PAs
Total amount of
								  single fee still owed PAs
__________
__________
__________
__________
SURCHARGES
Total amount of surcharge
								  billed
Total amount of surcharg e waived
Total Amount of
								  Surcharge collected
Total collections remitted to State
Total
								  Amount owed to State
CUPA Oversight
CalARP
UST
APSA
Refinery Safety
Tier 1
Tier 2
Tier 3
Tier 4
SURCHARGE TOTALS
COUNTS
Businesses Assessed CUPA Oversight
								  Surcharge
Aboveground Storage Tank Facilities with the
								  Capacity to Store 10,000 Gallons or More of Petroleum Assessed the APSA
								  Surcharge
Businesses Assessed the CalARP Program
								  Surcharge
Onsite Hazardous Waste Treatment Facilities:
Permit by Rule
Onsite Hazardous Waste Treatment
								  Facilities:
Conditional Authorization
Onsite
								  Hazardous Waste Treatment Facilities:
Conditional Exemption,
including Conditionally Exempt Commercial Laundries (CECL), Conditionally
								  Exempt Specified Wastestreams (CESW), Conditionally Exempt Small Quantity
								  Treatment (CESQT), and Conditionally Exempt Limited (CEL).
Hazardous Waste Generators
RCRA
								  Large Quantity Hazardous Waste Generators
(RCRA LQGs)
Large Quantity Hazardous Waste Generators
(LQGs)
Small Quantity Hazardous Waste Generators
(SQGs)
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