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CPG # TO: OF 'E OF REVENUE AND RECOVERY �nRCOPY <br /> TRANSMITTAL <br /> RSOPHEAK <br /> NT NO. DEPT.NO. <br /> REFERRAL <br /> 026000.0 <br /> RANTOR - FIRST MI TITLE <br /> LAST - AKA - FIRST MI TITLE <br /> SERVICE <br /> GUARANTOR SSN <br /> EAS SAN <br /> MAILING STREET CITY ST ZIP COD7AP JAAS AUTO SERVICE 414 MARTIN LUTHER KING JR. BLVD STOCKTON CA 95206 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3733 GENOVA LANE STOCKTON CA. 95212 209-981-3237 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM IN MONTHLY PAY AMT <br /> 12905 HA3/15/12 <br /> ZMAT <br /> LAST - RECIPIENT - FIRST MI TITLE CIPIENT USER REFERENCE NO/NARRATIVE <br /> SE VICE D TE: DATE OF <br /> STA T STOP MED REC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> 230 042000.0 2012 Hazmat Fee $130.00 p8q P43009-01 <br /> 30 042 00 0 Hazmat Penalty Fee $13.00 p8q 04 00 .0 <br /> p8q q42 00 0 I Sm Hw Gen <5 Tons/yr $213.00 p8q P43009.01 <br /> p8q I 0I42q0010 I Permit Fee Penalty $213.00 p8q P4300P.0 <br /> 8 01412 0010 1 State Surcharge Fee $24.00 p8q P44009-01 <br /> 8 0 2 00 0 Electronic Surcharge Fee $25.00 p8q <br /> 60 11 002q001p j p8q <br /> TOTAL $618.00 <br /> PRIOR STREET CITY ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> JAAS AUTO SERVICE 209-888-5461 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 414 W CHARTER WAY STOCKTON CA 95206 <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 /> JAAS AUTO SERVICE 209-888-5461 <br /> EMPLOYER STREET ("ITY ST 71P CODF <br /> 414 W CHARTER WAY TO TON CA 95206 <br /> CHECKED BY JDATE .I COL. 20 (3/88) <br />