Laserfiche WebLink
CPG # TO: r`�FICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL ..+ Copy <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> OLIN CHLOR ALKALI PRODUCTS <br /> C/O NAME GUARANTOR SSN <br /> OLIN CHLOR ALKALI PRODUCTS <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 26700 BANTA RD TRACY CA 95304 4232603998 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO, <br /> 490 STUART ST CLEVELAND TN 37312 4233364891 <br /> USER REFERENCE NO, BILL kTAT CYCLE STATUS DATE BMd CBMd INT MONTHLY PAY AMT I PY <br /> 13538 HAZMAT 3/15/09 <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 CHARGEI DEPT. NO, DESCRIPTION AMOUNT <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 8 Chems @ $15.00 Each $120.00 <br /> 10% Late Charge $36.00 1019 W& <br /> State Surcharge Fee $24.00 F <br /> Calarp Surcharge Fee $270.00 <br /> TOTAL $690.00 <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 /> OLIN CHLOR ALKALI PRODUCTS 4232603998 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 26700 BANTA RD TRACY ETSCA 95304 <br /> S�AB 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 /> OLIN CHLOR ALKALI PRODUCTS 4232603998 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 26700 BANTA RD TRACY CA P5304 <br /> REPARED BY CHECKED BY JDATE COL M (3M) <br /> tTl <br />