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CPc,' # TO: Or�.ICE OF REVENUE AND RECOVERY COPY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNTNO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> AG EXPRESS TRANSPORTATION INC <br /> C/O NAME GUARANTOR SSN <br /> ISRAEL VARGAS <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE N0, <br /> AG EXPRESS TRANSPORTATION INC P.O. BOX 965 TRACY CA 95378 (209)835-5811 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 28399 S CHRISMAN RD TRACY CA 95304 209-835-5811 <br /> USER REFERENCE NO. IBILL kTAT CYCLE STATUS DATE BMd CBM IN MONTHLY PAY AMT <br /> 13683 HAZMAT 3/15/12 <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> S <br /> ERVICE TE: DATE OF ,� <br /> STOP MED REC NO CHARGE <br /> 'alDEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. RIP N AMOUNT <br /> 042000.0 2012 Hazmat Fee $300.00 8 4 00 .0 042 000 Hazmat Penalty Fee $30.00 8 4 00 .0 42 000 State Surcharge Fee $24.00 8 4 00 .0 <br /> 0 2 00 o Electronic Surcharge Fee $25.00 8P41009.01 <br /> 80 014290010 8 4 00 .0 <br /> 80 014290010 8 4 00 .0 <br /> 80 0 2 00 8Q P44009.0 <br /> TOTAL $379.00 <br /> GUARANTOR <br /> PRIOR STREET QATY RT ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NOI <br /> AG EXPRESS TRANSPORTATION INC (209)835-5811 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 7553 W CARMELO AVE TRACY CA 95304 <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> AG EXPRESS TRANSPORTATION INC (209)835-5811 <br /> EMPLOYER STREET CITY �,T 71P conF <br /> 7553 W CARMELO AVE TR CA 95304 <br /> RV CHECKEDBY col 20 (31M) <br />