Cal. Code Regs. Tit. 27, div. 1, 4, ch. 1, pt. II, art. 10, app C
Current through Register 2024 Notice Reg. No. 50, December 13, 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) | |||||
Cal. Code Regs. Tit. 27, div. 1, 4, ch. 1, pt. II, art. 10, app C