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CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL /�� O (��/f <br /> ACCOUNT NO. DEPT. N REFERRALS\\(`�j ',IIVrJ \U/ <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> A PLUS READY MIX <br /> C/O NAME GUARANTOR SSN <br /> ROD LAWLEY <br /> MAILING STREET CITY ST ZIPCODE AREA PHONE NO. <br /> A PLUS READY MIX 2710 LOOMIS RD STOCKTON CA 95205 209-462-9168 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2710 LOOMIS RD STOCKTON CA 95205 209-462-9168 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATEI BMd CBMd INT MONTHLY PAY AMT I PYMT FHOB <br /> 13475 HAZMAT 3/20/10 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NOMARRATIVE <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 2010 Hazmat Fee $390.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $39.00 <br /> TOTAL $478.00 <br /> GUARANTOR <br /> DOB DR LIC NO----F AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> A PLUS READY MIX 209-462-9168 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1115 E LOCKEFORD ST LODI CA 95242 <br /> SPOUS& CO-OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO I AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> A PLUS READY MIX 209-462-9168 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1115 E LOCKEFORD ST COLA _ CA 95242 <br /> PREPARED BY CHECKED BY ATE of 'r 1/0 COL. 20 (3RB) <br />