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

Current through Register 2024 Notice Reg. No. 44, November 1, 2024
Appendix C - Reports and Forms

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 ElementAmount 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 FEETotal amount of single fee billedTotal amount of single fee waivedTotal amount of single fee collected
______________________________
PARTICIPATING AGENCIESAmount of single fee billed for PAsTotal amount of single fee collected for PAsTotal amount of single fee remitted for PAsTotal amount of single fee still owed PAs
________________________________________
SURCHARGESTotal amount of surcharge billedTotal amount of surcharg e waivedTotal Amount of Surcharge collectedTotal collections remitted to StateTotal 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 SurchargeAboveground Storage Tank Facilities with the Capacity to Store 10,000 Gallons or More of Petroleum Assessed the APSA SurchargeBusinesses Assessed the CalARP Program Surcharge
Onsite Hazardous Waste Treatment Facilities: Permit by RuleOnsite Hazardous Waste Treatment Facilities: Conditional AuthorizationOnsite 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 GeneratorsRCRA Large Quantity Hazardous Waste Generators (RCRA LQGs)Large Quantity Hazardous Waste Generators (LQGs)
Small Quantity Hazardous Waste Generators (SQGs)

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