Laserfiche WebLink
TO: OFFICE OF REVENUE & RECOVERY <br /> CPG: ACCOUNT TRANSMITTAL <br /> ACCOUNT NO DEPT NO REFERRAL DATE <br /> a3 ► 3 0420000 0-3 <br /> LAST- -GUARANTOR. FIRST MI LAST A" FIRST MI <br /> Evans Robert <br /> CIO NAME SSNI FED# DR.LIC.NO. <br /> Elon Inc <br /> MAILING STREET CITY ST ZIP AREA PHONE# <br /> 22865 HenryRd Escalon CA 95320 <br /> FACILITY ADDRESS CITY ST <br /> 17333 S Comconex Rd Manteca CA 95336 <br /> USER REFERENCE NO <br /> Invoice#236550 <br /> COMMENTS: <br /> SERVICE DATE: <br /> START: 2/112013 STOP: 2/1/2013 <br /> CHARGE CHARGE <br /> No DEPT NO DESCRIPTION AMOUNT NO DEPT NO DESCRIPTION AMOUNT <br /> Inv#236550 <br /> 380 SM HW Generator 213.00 <br /> 380 State Surcharge Fee 35.00 <br /> 380 AST Fac 10K<1100 675.00 <br /> 380 Permit Penalty Fee 213.00 <br /> 380 Permit Penalty Fee 675.00 <br /> TOTAL 1,811.00 <br /> EMPLOYER NAME/SOURCE OF INCOME: EMPLOYER PHONE# <br /> EMPLOYER STREET CITY ST ZIP <br /> PREPARED BY: DATE: /-2 /J' <br /> REVIEWED BY: DATE: 913115 <br />