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'PG # _ TO: 6T'''CE OF REVENUE AND RECOVERY � � <br /> 11 TRANSMITTAL "" COPY OO �p <br /> .A000UNTNO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> PAUL'S AUTO REPAIR <br /> C/O NAME GUARANTOR SSN <br /> PAUL W WONG <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1146 ENTERPRISE ST STOCKTON CA 95204 209-462-6828 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 209-462-6828 <br /> USER REFERENCE NO. BILL kTAT CYCLE STATUS DATE BMd CBMd INd MONTHLY PAY AMT <br /> 11966 HAZMAT 3/15/12 <br /> LAST - RECIPIENT - FIRST MI TITLE --RECIPIENT USER REFERENCE NO/NARRATIVE <br /> Dog <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 042000.0 2012 Hazmat Fee $100.00 P89 <br /> 30 1 014290010 1 Hazmat Penalty Fee $10.00 P89104300P.01 <br /> p8q I q429OOrO Sm Hw Gen <5 Tons/yr $213.00 p8q <br /> �8q I 021QOOIO I Permit Fee Penalty $213.00 p8q <br /> 80 1 0 2 00 0 State Surcharge Fee $2 . p8q <br /> 1 1 <br /> s0 1, 014290010 Electronic Surcharge Fee 1 $25.008 4 00 .0 <br /> So 0 2 00. 8 4 00 .0 <br /> TOTAL $585.00 <br /> GUARANTOR <br /> nnpt DR I Ir NO Al ITO I Ir NO <br /> PRIOR STREET CITY RT I ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> PAUL'S AUTO REPAIR 209-462-6828 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1146 ENTERPRISE ST STOCKTON CA 95204 <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> PAUL'S AUTO REPAIR 209-462-6828 <br /> EMPLOYERSTREET CITY RT 71P rnnF <br /> 1146 ENTERPRISE ST TOCK N CA 95204 <br /> Ry <br /> CHEC ED BY DATE COL 20 (3188) <br />