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CPG' # TO: OFFICE OF REVENUE AND RECOVERY ACCOUNT TRANSMITTAL COPYACCOUNTNO. DEPT.NO. REFERR <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> V&W DRILLING INC <br /> C/O NAME GUARANTOR SSN <br /> ROBERT VICKERY <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> V&W DRILLING INC 3806 DUCK CREEK DR STOCKTON CA 95215 209-469-7700 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> P.O. BOX 549 WALLACE CA 95254 209-329-7742 <br /> USER REFERENCE NO. IBILL kTAT ICYCLE ISTATUS DATEI BM CBMd IN MONTHLY PAY AMT IYMT PROS <br /> n'-P MATP TERM DATf- <br /> 14187 HAZMAT 3/15/12 <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE D DATE OF <br /> TART STOP MED REC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> 230 042000.0 2012 Hazmat Fee $285.00 p8q <br /> 1 1 <br /> 30 1 014290010 1 Hazmat Penalty Fee $28.50 p8q10 4009.01 <br /> p8q I q429OOtO I State Surcharge Fee $24.00 p8q <br /> p8q 0 2 00 0 Electronic Surcharge $25.00 p8q <br /> 80 1 0 2 00 0 -I p8q 1 P43009.01 <br /> 80 1 0I42q0010 I p8q <br /> 8 0 2ql]10.p p8q400 .0 <br /> TOTAL $362.50 <br /> GUARANTOR <br /> PRIOR STREET riTy RT ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> V&W DRILLING INC 209-469-7700 <br /> EMPLOYERSTREET CITY ST I ZIP CODE <br /> 3806 DUCK CREEK DR STOCKTON CA 95215 <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 /> V&W DRILLING INC 209-469-7700 <br /> EMPLOYER STREET CITY ST 71P r.0QF <br /> 3806DUCK CREEK DR $TOC TON CA 95215 <br /> R;zpRED RY 64L41 <br /> 1 4 CHECKED BY DATE <br />