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BILLING
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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E
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ELM
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103
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1900 - Hazardous Materials Program
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PR0520178
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BILLING
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Entry Properties
Last modified
10/12/2020 10:51:51 PM
Creation date
6/9/2018 2:12:37 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
BILLING
RECORD_ID
PR0520178
PE
1920
FACILITY_ID
FA0010236
FACILITY_NAME
BILL DEEMER'S AUTO AFFAIR
STREET_NUMBER
103
Direction
E
STREET_NAME
ELM
STREET_TYPE
ST
City
LODI
Zip
95240
CURRENT_STATUS
Active, billable
SITE_LOCATION
103 E ELM ST
P_LOCATION
02
P_DISTRICT
004
Supplemental fields
FilePath
\MIGRATIONS\E\ELM\103\PR0520178\BILLING.PDF
QuestysFileName
BILLING
QuestysRecordDate
6/25/2015 7:22:51 PM
QuestysRecordID
2774629
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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CPG # TO: 'wFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTALt0lpy <br /> 1,1 <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> LAKEWOOD AUTO REPAIR <br /> C/O NAME GUARANTOR SSN <br /> KEN PAIGE JR <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 103 E ELM ST LODI CA 95240 209-333-6300 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2828 CINNAMON TEAL CIR ELK GROVE CA 95757 209-481-3011 <br /> R <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT PY B <br /> 7431 HAZMAT 3/15/09 <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 HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> Kin <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 4 Chems @ $15.00 Each $60.00 <br /> 10% Late Charge $30.00 01 <br /> State Service Fee $24.00 <br /> Sm Hz Gen<5 Tons/yr $213.00 <br /> Permit Fee Penalty $213.00 <br /> Addition Of 1 Chem $15.00 <br /> TOTAL $795.00 <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 /> LAKEWOOD AUTO REPAIR 209-333-6300 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 103 E ELM ST LODI CA 95240 <br /> SPASSE. CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> LAKEWOOD AUTO REPAIR 209-333-6300 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 103 E ELM ST LODI CA 1,95240 <br /> PREPARED BY CHECKED BY jDATE aJ coy 20 finee) <br />
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