Laserfiche WebLink
CPG # T0: JTFFICE OF REVENUE AND RECOVERY Copy <br /> ACCOUNT TRANSMITTAL � <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> NORTHERN CA REENTRY FACILITY <br /> C/O NAME GUARANTOR SSN <br /> CALIF DEPT OF CORRECTIONS <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 7150 E ARCH RD STOCKTON CA 95205 209-461-6270 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1515 S ST SACRAMENTO CA 95814 N/A <br /> T PROS <br /> USER REFERENCE NO. IBILL kTAT ICYCLE ISTATUS DATEI BM CBM INTI MONTHLY PAY AMT <br /> 6091 HAZMAT 4/15/11 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 042000.0 2011 Hazmat Fee $85.00 380 042000.0 <br /> 230 042000.0 Haz Mat Penalty Fee $8.50 380 042000.0 <br /> 380 042000.0 Sm Hw Gen<5 Tons/yr $213.00 380 042000.0 <br /> 380 042000.0 Permit Fee Penalty $213.00 380 042000.0 <br /> 380 042000.0 State Surcharge Fee $24.00 380 042000.0 <br /> 380 042000.0 Electronic Surcharge Fee $25.00 380 042000.0 <br /> 380 042000.0 380 042000.0 <br /> TOTAL $568.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> NORTHERN CA REENTRY FACILITY 209-461-6270 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 7150 E ARCH RD STOCKTON CA 95205 <br /> CO-OWNER <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> NORTHERN CA REENTRY FACILITY 209-461-6270 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 7150 E ARCH RD TOC ON CA 95205 <br /> PREPARED ISCHECKED BY DATE -7 'e2 7-7K ca n Offs <br />