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CPG' # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL C <br /> O Ll <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> TONY'S AUTO SERVICE 11 1 j 11 <br /> C/O NAME GUARANTOR SSN <br /> JOE M FRANCO <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1951 S EL DORADO ST STOCKTON CA 95206 209-688-2255 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1951 S ELDORADO ST STOCKTON CA 95206 209-688-2255 <br /> USER REFERENCE NO. BILL TAT ICYCLE STATUS DATE BMd CBM INd MONTHLY PAY AMT PROB <br /> 5505 HAZMAT 3/15/12 <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> TART STOP MED REC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT RCHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> NA <br /> 230 042000.0 2012 Hazmat Fee $85.00 4 00 .030 042 00o Hazmat Penalty Fee $8.50 11 00 .01 1 <br /> 8 42 00 o State Surcharge Fee $24.00 4 00 .01 1 <br /> 8 0 2 000 Electronic Surcharge $25.00 1 P4300 .o <br /> 1 1 <br /> 80 1 014290010 6043009.01 <br /> 80 1 014290010 8 4 00 .0 <br /> 1 1 <br /> 80 1 0 2 00.p I �8q P43009.01 <br /> TOTAL $142.50 <br /> GUARANTOR <br /> PRIOR STREET CITY ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> TONY'S AUTO SERVICE 209-688-2255 <br /> EMPLOYER STREET CITYST ZIP CODE <br /> 1951 S ELDORADO ST 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 /> TONY'S AUTO SERVICE 209-688-2255 <br /> EMPLOYER STREET <br /> 1951 S EL Wag <br /> ADO ST STOC TON CA 95206 <br /> 11PREPARED BY CHECKED BY IDATE COL. 20 (3188) <br />