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CPG,# ��_ TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL COPY <br /> REFERRAL <br /> ACCOUNT NO. DEPT. NO. <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> RELIANCE EXPRESS INC <br /> C/O NAME GUARANTOR SSN <br /> AVTAR S DEOL <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> RELIANCE EXPRESS INC 793 S TRACY BLVD 283 TRACY CA 95376 209-321-9601 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 10625 WATERBURY DRIVE STOCKTON CA 95209 209-469-5011 <br /> USER REFERENCE NO. IBILL bTAT ICYCLE ISTATUS DATE BMd CBMd INd MONTHLY PAY AMT <br /> 10669 HAZMAT 11 J I I I I I I 1 3/15/12 <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO, DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> 230 042000.0 2012 Hazmat Fee $85.00 P43009.01 <br /> 30 1 014290010 1 Hazmat Penalty Fee $8.50 p8q1043009.01 <br /> p8q q429OOrO State Surcharge Fee $24.00 p8qa 00 .0 <br /> Pq o 2900,0 Electronic Surcharge Fee $25.00 8q 1 P43009.01 <br /> 80 0141290010 8q 11 P44009.0 <br /> 80 11 0 2 000 8 43009.01 <br /> 80 1, 002400.p 8 43009.01 <br /> TOTAL $142.50 <br /> GU TOR <br /> PRIOR STREET rfTy RT ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> RELIANCE EXPRESS INC 209-321-9601 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1919 E CHARTER WAY STE B STOCKTON CA 95205 <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I 1 I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> RELIANCE EXPRESS INC 209-321-9601 <br /> EMPLOYER STREET ("ITY ST 71P rQQF <br /> 1919 E CHARTER WAY STE B CKTON CA 95205 <br /> CHECKED BY IDATE COL. 20 (3/88) <br />