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irte � <br /> TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL �O py <br /> ACCOUNT NO. REFERRAL <br /> DEPT. NO. <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST <br /> MI TITLE LAST - AKA - FIRST <br /> DOUBLE A TRUCK SVC MI TITLE <br /> C/O NAME <br /> ANDREW SALMERON SR GUARANTOR SSN <br /> MAILING STREET <br /> CITY ST ZIP CODE AREA PHONE NO. <br /> DOUBLE A TRUCK SVC P.O. BOX 1402 DISCOVERY BAY CA 94505 <br /> RESIDENCE STREET CITY 209-467-0873 <br /> ST ZIP CODE AREA PHONE NO. <br /> 2301 FIRWOOD CT DISCOVERY CA 94505 209-914-5653 <br /> USER REFERENCE NO, BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAV AMTF3/20/1 <br /> YMT R 8 <br /> RNA DATP <br /> 8084 HAZMAT 0 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NOMARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT, NO. DESCRIPTION AMOUNT <br /> 230 026000.0 Sm Hw Gen<5 Tons/yr $213.00 <br /> 2010 Hazmat Fee $285.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge Fee $25.00 <br /> Hazmat Penalty Fee $28.50 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $788.50 <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 /> DOUBLE A TRUCK SVC 209-467-0873 <br /> EMPLOYER STREET CITY ST I ZIP CODE <br /> 1675 W CHARTER WAY#D STOCKTON CA 95206 <br /> SPQUfS& CO—OWNER <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 /> DOUBLE A TRUCK SVC 209-467-0873 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1675 W CHARTER WAY S �CKTON CA 95206 <br /> PREPARED BY CHECKED BY DATE ,j- �0 co, <br /> I (3M) <br />