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AND RECOVERY <br /> To: OFFICEVE <br /> OF py <br /> CPG # � <br /> REFERRAL <br /> ACCOUNT NO. <br /> DEPT. NO. <br /> 026000.0 MI TITLE <br /> LAST - AKA - FIRST <br /> LAST - GUARANTOR - FIRST <br /> MI TITLE <br /> DELTA LIFT TRUCK & EQUIP GUARANTOR SSN <br /> CSO NAME <br /> STEVEN BUCHAN CITY ST ZIP CODE AREA PHONE NO. <br /> MAILING STREET <br /> DELTA LIFT TRUCK& EQUIP P.O. BOX 2124 LODI CA 95241 ST ZIP CODE AREA PHONE NO. <br /> CITY <br /> RESIDENCE STREET <br /> P M RO <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBMC INT MONTHLY PAY AMT <br /> 3/20/10 <br /> 14227 HAZMAT <br /> CHARGES <br /> LAST - RECIPIENT - FIRST <br /> MI TITLE RECIPIENT USER REFERENCE NOINARRATIVE <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 026000.0 2009 & 2010 Hazmat Fee $260.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge Fee $25.00 <br /> Correction To Charges -$49.00 <br /> Haz Mat Penalty Fee $26.00 <br /> TOTAL $286.00 <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 /> DELTA LIFT TRUCK& EQUIP <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 12811 BRANDT RD LODI CA 95240 <br /> SPAF1S& CO-OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> DELTA LIFT TRUCK& EQUIP <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 12811 BRANDT RD LODI, ,' CA 95240 <br /> REPARED IS I CHECKED BY DATE �/� S / COL. 20 (alae) <br />