Laserfiche WebLink
CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> sot ACCOUNT TRANSMITTAL COPY <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> A-CARE AUTO REPAIR <br /> C/O NAME GUARANTOR SSN <br /> GERALD TRIP <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1102 W FREMONT ST STOCKTON CA 95203 209-463-5600 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1102 W. FREMONT STOCKTON CA. 95203 209-463-5600 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE amd CBM INT MONTHLY PAYAMT <br /> 14647 HAZMAT 11/15/11 <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 NQ DEPT. NO. DESCRIPTION AMOUNT <br /> kin t380042,000.0 <br /> 00.0 2007 - 2011 Hazmat Fee $425.00 380 042000.0 <br /> 00.0 Hazmat Penalty Fee $42.50 380 042000.0 <br /> 00.0 Sm Hw Gen<5 Tons/yr $213.00 380 042000.0 <br /> 00.0 380 042000.0 <br /> 00.0 380 042000.0 <br /> 00.0 311 L80 042000.0 <br /> 380 042000.0 <br /> TOTAL $680.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> A-CARE AUTO REPAIR 209-463-5600 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> _j <br /> 1102 W FREMONT ST STOCKTON CA 95203 <br /> CO-OWNER <br /> AST FIRSTMITITI-F SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> A-CARE AUTO REPAIR 209-463-5600 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1102W FREMONT ST ST CKT N CA 95203 <br /> REPARED BY CHECKED BY JDATE I COL. zo loiael <br />