Surcharge Forms and Booklets

SUMMARY OF SURCHARGE PROGRAM

For more information on the Sanitation Districts' surcharge program, contact the Surcharge Processing Group at
(562) 908-4288, extension 2600 or by email surchargeinfo@lacsd.org.

Please note that the electronic versions of the tables in Microsoft EXCEL are offered for your convenience only. The Sanitation Districts do not guarantee the accuracy of calculations performed using the electronic tables. Carefully review your surcharge statement before submission to ensure accuracy. Inaccurate surcharge filings may be subject to penalties and/or interest fees.

Surcharge Form Tables (The following tables can be located within this file for the current fiscal year [XLS - Microsoft Excel format])

The Sanitation Districts now offer electronic versions of Table 1, Table 2A, Table 2B, and Table 3. Hard copies of these tables may be filed in lieu of the tables included in the Surcharge Statement booklets. The tables are in Excel format and appropriate software is needed to use them.

  • Table 1 - Multiple Discharge Outlet Summary
  • Table 2A - Water Usage Verification Table
  • Table 2B - Adjusted Meter Water Supply
  • Table 3 - Chemical Oxygen Demand & Suspended Solids Summary

Use the appropriate Table below based on your method of flow volume determination:

  • Table 3A - Metered Water Supply
  • Table 3B - Adjusted Metered Water Supply
  • Table 3C - Direct Determination (sampling frequency of bimonthly or less)
  • Table 3D - Direct Determination (weekly sampling frequency)
  • Table 3E - Direct Determination (biweekly sampling frequency)
  • Table 3F - Direct Determination (daily sampling frequency)

Surcharge Form Booklets - Fiscal Year 2016/2017

  • Long Form Booklet Instructions (PDF)
    • Long Form Direct Measurement - Single Outlet (XLS)
    • Long Form Direct Measurement - Multiple Outlets (XLS)
    • Long Form Adjusted Metered Assumed 2.00 Peak - Single Outlet (XLS)
    • Long Form Adjusted Metered Assumed 2.00 Peak - Multiple Outlets (XLS)
  • Short Form Booklet Instructions (PDF)
    • Short Form (XLS)
  • User Charge Form Booklet Instructions (PDF)
    • User Charge Form (XLS)

Surcharge Form Booklets - Fiscal Year 2015/2016

  • Long Form Booklet
    • Long Form Direct Measurement - Single Outlet (XLS)
    • Long Form Direct Measurement - Multiple Outlets (XLS)
    • Long Form Adjusted Metered Assumed 2.00 Peak - Single Outlet (XLS)
    • Long Form Adjusted Metered Assumed 2.00 Peak - Multiple Outlets (XLS)
  • Short Form Booklet
    • Short Form (XLS)
  • User Charge Form Booklet
    • User Charge Form (XLS)

Surcharge Form Booklets - Fiscal Year 2014/2015

  • Long Form Booklet (PDF)
    • Long Form Direct Measurement - Single Outlet (XLS)
    • Long Form Direct Measurement - Multiple Outlets (XLS)
    • Long Form Adjusted Metered Assumed 2.00 Peak - Single Outlet (XLS)
    • Long Form Adjusted Metered Assumed 2.00 Peak - Multiple Outlets (XLS)
  • Short Form Booklet (PDF)
    • Short Form (XLS)
  • User Charge Form Booklet (PDF)
    • User Charge Form (XLS)