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) |
Cal. Code Regs. Tit. 27, div. 1, 4, ch. 1, pt. II, art. 10, app C