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CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL '"0 C� O PQ � <br /> ACCOUNT NO, DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> END OF THE LINE AUTO REPAIR <br /> C/O NAME GUARANTOR SSN <br /> DARREN YESCAS <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> END OF THE LINE AUTO REPAIR 200 S COMMERCE ST LODI CA 95240-0841 209-365-6077 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1124 S. COUNTRY CLUB BLVD. STOCKTON CA 95204 209-981-5390 <br /> USER REFERENCE NO. L TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT PY T PR B <br /> BIL <br /> 10220 HAZMAT 3/20/10 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <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 /> Correction To A Charge -$187.00 <br /> TOTAL $601.50 <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 /> END OF THE LINE AUTO REPAIR 209-365-6077 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 200 COMMERCE ST#101 LODI CA 95240-0841 <br /> Sg9i-M 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 /> END OF THE LINE AUTO REPAIR 209-365-6077 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 200 COMMERCEOD CA 95240-0841 <br /> PREPARED T#10 CHECKED BY - DATE j (7 COL. 20M) <br />