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CPC # TO: O -CE OF REVENUE AND RECOVERY <br /> nrr0TTm7 TRANSMITTAL \ C 0 py <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> VALLEY SMOG <br /> C/O NAME GUARANTOR SSN <br /> KASHIF KHAN <br /> MAILING STREET CITY ST ZIPCODE AREA PHONE NO. <br /> 325 E KETTLEMAN LN LODI CA 95240 209-334-0305 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 325 KETTLEMAN LANE LODI CA 95240 209-334-0305 <br /> USER REFERENCE NO, BILL TAT CYCLE STATUS DATE BMd CBMd INd MONTHLY PAY AMT <br /> 14352 HAZMAT 1 11 11 1 1 1 1 1 1 1 1 1 1 1 . 3/15/12 <br /> LAST - RECIPIENT - FIRST MI TITLE --RECIPIENT USER REFERENCE NOINARRATIVE <br /> SERVICED DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> PjR <br /> 230 042000.0 2012 Hazmat Fee $100.00 8P43009.01 <br /> 30 042 00 0 Haz Mat Penalty Fee $10.00 8 104300P.0 <br /> 8 42 00 0 Sm Hw Gen <5 Tons/yr $213.00 8P4;009-0 <br /> 8 04290010 Permit Fee Penalty $213.00 p8q P43009-01 <br /> 8 0 10010 11 State Surcharge Fee $24.00 g P43009.0 <br /> 80 0 2 0010 J Electronic Surcharge Fee $25.00 p8q P4300P.0 <br /> ?8q I 002(l0010 11 p8q400 .0 <br /> TOTAL $585.00 <br /> PRIOR STREET �PC <br /> EMPLOYER NAME EMPLOYER P"ONE <br /> VALLEY SMOG 209-334-0305 <br /> EMPLOYERSTREET CITY STZIPCODE <br /> 325 E KETTLEMAN LN LODI CA 95240 <br /> ST FIRST MI TITLE SOC SEC NO. I DOB I DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> VALLEY SMOG 209-334-0305 <br /> EMPLOYERSTREET <br /> 325E KETTLE% L L DI - CA 95240 <br /> CHECKED BY JDATE COL. 20(a�eel <br />