Form 26R PDF Details

Form 26R is a document that is used to report and pay your state's use tax. This form is required to be filed by all taxpayers who have made taxable purchases in the previous year totaling more than $1,000 from out-of-state retailers. Use tax is a tax that is similar to sales tax, but it is imposed on purchases of goods and services that are not taxed when they are sold. The purpose of Form 26R is to help you report and pay your state's use tax on taxable purchases. You can file this form electronically or through the mail. If you choose to file electronically, you will need to register for an account with the Department of Revenue. There are several ways to pay your use tax, including online payments, check or money order payments, and credit card payments. For more information about how to file and pay your state's use tax, visit the Department of Revenue website.

QuestionAnswer
Form NameForm 26R
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other names26r form padep, form 26r dep, pa dep 26r, form 26r padep fillable form

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2540-PM-BWM0347

Rev. 1/2011

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMMONWEALTH OF PENNSYLVANIA

 

 

 

 

 

 

 

 

 

 

 

DEPARTMENT OF ENVIRONMENTAL PROTECTION

 

 

 

 

 

 

 

 

 

 

 

BUREAU OF WASTE MANAGEMENT

 

 

 

 

 

 

 

 

 

 

 

 

FORM 26R

 

 

 

 

 

 

 

 

 

 

CHEMICAL ANALYSIS OF RESIDUAL WASTE

 

 

 

 

 

 

 

 

ANNUAL REPORT BY THE GENERATOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This form must be fully and accurately completed. All required information must be

 

 

 

DEP USE ONLY

 

typed or legibly printed in the spaces provided. If additional space is necessary, identify

 

 

Date Received & General Notes

 

each attached sheet as Form 26R, reference the item number and identify the date

 

 

 

 

 

 

 

prepared. The date on attached sheets needs to match the date noted below.

 

 

 

 

 

 

 

General Reference 287.54

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date Prepared/Revised

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION A. CLIENT (GENERATOR OF THE WASTE) INFORMATION

 

 

Company Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If a Subsidiary, Name of Parent Company

 

 

 

 

 

 

 

 

EPA Generator ID#

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Company Mailing Address Line 1

 

 

 

Company Mailing Address Line 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Company Address Last Line – City

 

State

 

Zip+4

 

 

Phone

 

 

Ext

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Company Contact Last Name

First Name

 

 

MI

 

 

 

Suffix

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Municipality

 

 

 

 

County

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contact Phone

Ext

Contact Email Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is the waste generated at the Company Mailing Address (noted above)?

 

 

 

Yes

No

 

If ‘No’, describe location of waste generation and storage.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Municipality

 

County

 

 

 

 

 

 

 

State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION B. WASTE DESCRIPTION

 

 

 

 

 

 

 

 

Residual

 

Residual Waste

 

 

 

 

 

 

 

Unit of

 

 

Time

 

Waste Code

 

Code Description

 

Amount

 

 

 

Measure

 

 

Frame

 

 

 

 

 

 

 

 

 

 

 

 

 

cu yd

gal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

lb

ton

 

One Time

 

 

 

 

 

 

1. GENERAL PROPERTIES

 

 

 

 

 

 

 

a.

pH Range

 

to

(based on analyses or knowledge)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b.

Physical State

Liquid Waste (EPA Method 9095)

 

 

 

 

 

 

 

 

 

 

 

Solid (EPA Method 9095)

 

 

 

 

 

 

 

 

 

 

 

Gas (ambient temperature & pressure)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c.

Physical Appearance

Color

 

 

 

 

Odor

 

 

 

 

 

 

 

 

 

 

 

Number of Solid or Liquid Phases of Separation

 

 

 

 

 

 

 

 

 

 

 

Describe each phase of separation.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. CHEMICAL ANALYSIS ATTACHMENTS

 

 

 

 

 

 

 

a.

The results of a detailed chemical characterization of the waste, as described in the

Yes

No

 

 

instructions, is attached.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b.

A detailed description of the waste sampling method is attached.

 

 

 

Yes

No

 

 

 

 

 

 

 

 

c.

The quality assurance/quality control procedures employed by the laboratory(ies) is

Yes

No

 

 

attached.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d.

The results of the hazardous waste determination is attached.

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

e.

If applicable, a detailed explanation supporting use of generator knowledge in

 

 

Yes

No

N/A

 

 

lieu of actual chemical analysis is attached.

 

 

 

 

 

 

 

 

 

 

 

- 1 -

2540-PM-BWM0347 Rev. 1/2011

3. PROCESS DESCRIPTION & SCHEMATIC ATTACHMENTS

a.

A detailed description of the manufacturing and/or pollution control processes producing

Yes

No

 

the waste, as specified in the instructions, is attached.

 

 

 

 

 

 

 

 

 

 

b.

A schematic of the manufacturing and/or pollution control processes producing the waste,

Yes

No

 

as specified in the instructions, is attached.

 

 

 

 

 

 

 

 

 

 

 

 

c.

If portions of the information submitted are confidential, the substantiation for

Yes

No

N/A

 

a confidentiality claim, as described in the instructions, is attached.

 

 

 

 

 

 

 

 

 

 

SECTION C. MANAGEMENT OF RESIDUAL WASTE

 

 

 

 

1. PROCESSING OR DISPOSAL FACILITY(IES)

 

 

 

The area below (a.-d.) will accommodate the identification of two facilities. Attach additional sheets if necessary.

 

 

 

 

 

 

 

a.

Solid waste permit number(s) for processing or disposal facility being utilized.

 

 

 

 

 

 

 

 

 

 

 

 

b.

Facility Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address Line 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address Line 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address City State ZIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Municipality

 

County

 

 

 

 

 

 

 

 

 

 

 

 

c.

Facility Contact Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone

 

Email Address

 

 

 

 

 

 

 

 

 

d.

Volume of waste shipped to processing or disposal facility in the previous year.

 

 

 

 

 

cu yd

gal

lb

ton

(check one)

 

 

 

 

 

 

 

a.

Solid waste permit number(s) for processing or disposal facility being utilized.

 

 

 

 

 

 

 

 

 

 

 

b.

Facility Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address Line 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address Line 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address City State ZIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Municipality

 

County

 

 

 

 

 

 

 

 

 

 

 

 

c.

Facility Contact Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone

 

Email Address

 

 

 

 

 

 

 

 

 

d.

Volume of waste shipped to processing or disposal facility in the previous year.

 

 

 

 

 

cu yd

gal

lb

ton

(check one)

 

 

 

 

 

 

 

 

 

 

 

 

 

2. BENEFICIAL USE

 

 

 

 

a.

Has the waste been approved for beneficial use?

 

 

 

Yes

No

 

If “Yes”, list the general permit number or approval number.

 

 

 

 

 

 

 

 

 

 

 

b.

Volume of waste beneficially used in the previous year.

 

 

 

 

 

 

 

cu yd

gal

lb

ton

(check one)

 

 

- 2 -

2540-PM-BWM0347 Rev. 1/2011

SECTION D. CERTIFICATION

I certify, under penalty of law, that I have personally examined and am familiar with the information submitted in this Annual Report and all attached documents and that based upon my inquiry of those individuals immediately responsible for obtaining the information, I verify that the submitted information is true, accurate and complete to the best of my knowledge. I understand that the submission of false information herein is made subject to the penalties of 18 Pa. C.S. §4904, relating to unsworn falsification to authorities, which include fine and imprisonment.

Check the following, if applicable:

I certify the information required in Section B-1, General Properties was supplied to the Department for the year and has not changed.

Form Submitted:

Date Submitted:

Form 26R

Other (specify)

I certify the information required in Section B-2, Chemical Analysis was supplied to the Department for the year and has not changed.

Form Submitted:

Date Submitted:

Form 26R

Other (specify)

I certify the information required in Section B-3, Process Description and Schematic, was supplied to the Department

for the year

 

and has not changed.

Form Submitted:

Date Submitted:

Form 26R

Other (specify)

Name of Responsible Official

Title

 

 

 

Signature

 

Date

- 3 -

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