Department of Taxation and Finance

                                    Quarterly Return for Special Assessments on                                                                                                           TP-550(12/16)
                                    Hazardous Waste Generated in New York State

                                                                                                                                         Use this form to report any transactions for the quarter:
Read Form TP-550-I, Instructions for Form TP-550, before making any entries.                                                                                           through
                                                                                                                                         File on or before the 20 thday of the month following the end of 
                                                                                                                                         the quarter.
                                    Amended return
                  Environmental protection agency (EPA) ID number                                                                        Employer identification number (EIN) or social security number (SSN)

                  Generator’s legal name

                  Generator’s mailing address (number and street with apartment or suite number, or PO Box)                              City                              State            ZIP code

    Print or type Hazardous waste site name

                  Hazardous waste site address (number and street; not a PO box)                                                         City                              State            ZIP code

                                               Change of business information? See Business informationin Form TP-550-I.

Computation of net tons subject to assessment for the quarter
  1   Tons of hazardous waste generated in New York State that were treated or disposed of on-site during
       the reporting quarter, or were removed from or designated for removal from the site of generation
       during the reporting quarter for treatment, disposal, or storage prior to such treatment or disposal  ........................                                     1 
 2  Tons of hazardous waste reported on line 1 that were treated or disposed
       of on-site, except by incineration or landfill disposal  .....................................                                 2
  3 Tons of hazardous waste reported on line 1 that were subject to exemptions
                  (see instructions)  ..............................................................................................  3
  4 Tons of hazardous waste recovered from a materials recovery process ..........                                                    4
  5 Tons of hazardous waste not subject to assessments (add lines 2, 3, and 4)  .............................................................                             5
  6 Total tons of hazardous waste subject to assessments (subtract line 5 from line 1)  ....................................................                              6

Computation of special assessments on hazardous waste for the quarter                                                                      Tons  (to nearest 1/10 ton)    × Rate          =     Assessment
  7   Tons of hazardous waste disposed of in a landfill on the site of generation  .....                                              7                                   × $ 27  =
  8 Tons of hazardous waste designated for removal or removed from the site of
      generation for disposal in a landfill or storage prior to disposal in a landfill  .......                                       8                                   × $ 27  =
 9  Tons of hazardous waste designated for removal or removed from the site of
     generation for treatment or disposal (except by landfill or incineration), or 
     storage prior to such treatment or disposal  .....................................................                               9                                   × $ 16  =
 10 Tons of hazardous waste designated for removal or removed from the site of
     generation for incineration or storage prior to incineration  ..............................                                     10                                  × $ 9  =
 11 Tons of hazardous waste incinerated on site of generation  .............................                                          11                                  × $ 2  =
 12 Total tons of hazardous waste subject to assessments (add Tons column,
       lines 7 through 11)  ..........................................................................................                12
 13 Total assessments for current quarter (add Assessment column, lines 7 through 11; see instructions for  
      important information)  ......................................................................................................................................................... 13
 14 Interest due for late payment (see instructions)  .....................................................................................................................             14
 15 Additional charges for late filing and/or late payment (see instructions)  ................................................................................                         15
 16 Total due (add lines 13, 14, and 15)  .......................................................................................................................................       16
 17 Total remittance: Make check or money order payable to the Commissioner of Taxation and Finance  ............................                                                       17
Certification: I certify that this return is to the best of my knowledge and belief true, correct, and complete.
                  Printed name of authorized person                              Signature of authorized person                                                        Official title
 Authorized
 person             Email address of authorized person                                                                                               Telephone number                     Date
                                                                                                                                                     (      )
    Paid            Firm’s name (or yours if self-employed)                                                                                      Firm’s EIN                             Preparer’s PTIN or SSN
 preparer           Signature of individual preparing this return                Address                                                                       City                       State ZIP code
    use
    only            Email address of individual preparing this return                                                                            Preparer’s NYTPRIN    or  Excl. code  Date
 (see instr.)

Page 2 of 2 TP-550 (12/16)

                                            Mailing instructions
  1.  Keep a completed copy of Form TP-550 for your records.
  2.  Attach a check or money order payable in U.S. funds to: Commissioner of Taxation and Finance.
  3.  Write your EIN, Form TP-550, and the quarter covered by this return in the memo area of your check or money order.
  4.  Mail this return along with your check or money order to: NYS TAX DEPARTMENT
                                                                RPC-HAZARDOUS WASTE
                                                                W A HARRIMAN CAMPUS
                                                                ALBANY NY 12227-0863
If not using U.S. Mail, see Publication 55, Designated Private Delivery Services.