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CPC * TO: ICE OF REVENUE AND RECOVERY Copy ACCOUNT TRANSMITTAL 1 DATE <br /> 4JOHNCERVAVNTESFI <br /> DEPT.NO. REFERRAL <br /> 026000.0 <br /> PJC <br /> FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> GUARANTOR SSN <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> JCTRUCKING P.O. BOX 6008 STOCKTON CA 95206-0008 209-944-0141 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 7185 E MAIN ST STOCKTON CA 95215 209-944-0141 <br /> USER REFERENCE NO. IBILLI STA CYCLE1 STATUS DATE BMd CBMC INT MONTHLY PAY AMTROB <br /> IDATE <br /> 9958 HAZMAT 11 3/15/07 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENTQnR USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. CHARGE <br /> NO DESCRIPTION AMOUNT T _ CRIPTION AMOUNT <br /> 230 026000.0 2007 Hmmp Annual Fee $240.00 NO I <br /> 8 Chems @ $15.00 Each $120.00 <br /> 10% Late Charge $36.00 <br /> State Service Fee $24.00 <br /> Sm Hz Gen <5 Tons/yr $206.00 <br /> Permit Fee Penalty $206.00 <br /> TOTAL $832.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> JC TRUCKING 209-944-0141 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1415 W ANDERSON ST STOCKTON CA 95206-0008 <br /> S-F6HffE' CO-OWNER <br /> LAST FIRST MI TITLEJ SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> JC TRUCKING 209-944-0141 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1415W ANDERSON ST STOC ON CA 95206-0008 <br /> PREPARED BY I CHECKED B DATE / COL. 20 (N88 <br />