Laserfiche WebLink
CBG # 4 TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL �./ py <br /> ACCOUNT NO. DEPT. NO REFERRAL (0 <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> STOCKTON ROOFING CO INC <br /> C/O NAME GUARANTOR SSN <br /> C A LEASE <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> STOCKTON ROOFING CO INC P.O. BOX 1169 STOCKTON CA 95201 209-639-3641 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 117 FOUNTAIN AVE PACIFIC GROVE CA 93950 831-373-4383 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE IM CBM INT MONTHLY PAY AMT <br /> I Ell. <br /> PYMT PR B <br /> 3/20/10 <br /> R <br /> 2221 HAZMAT <br /> CHAGES <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 /> 230 026000.0 Sm Hw Gen<5tons/yr $213.00 <br /> 2010 Hazmat Fee $270.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge Fee $25.00 <br /> Hazmat Penalty Fee $27.00 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $772.00 <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 /> STOCKTON ROOFING CO INC 209-639-3641 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2712 E FREMONT ST STOCKTON CA 95205 <br /> SPOUS& 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 /> STOCKTON ROOFING CO INC 209-639-3641 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2712 E FREMONT STS CK CA 95205 <br /> PREPARED BY CHECKED BY DATE 1 coy. so (sree) <br />