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CPG # T0: OE ;E OF REVENUE AND RECOVERY I--, O py <br /> TRANSMITTAL <br /> ACCOUNT NO. DEPT,NO. REFERRAL I--, <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> CONTINENTAL MUFFLER <br /> C/O NAME GUARANTOR SSN <br /> HECTOR OSORIO <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 230 E LODI AVE LODI CA 95240 209-368-1360 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3606 HEPBURN CIR STOCKTON CA 95209 N/A <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM IN MONTHLY PAY AMT <br /> 9829 HAZMAT 3/15/12 <br /> LAST - RECIPIENT - FIRST MI TITLE CIPIENT USER REFERENCE NO/NARRATIVE <br /> =NO. OESCRIPTION <br /> ' DATE OF <br /> P MED REC NO CHARGE <br /> DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT 2012 Hazmat Fee $100.00 8 4 00 .0 Hazmat Penalty Fee $0.00 8 1043009.01 1 <br /> 0 Sm Hw Gen <5 Tons/yr $213.00 8P43009-01 <br /> p8q 1 014290010 Permit Fee Penalty $0.00 p8q <br /> 80 0 2 00 0 State Surcharge Fee $24.00 p8q 4 00 .0 <br /> 80 1 014290010 Electronic Surcharge Fee $25.00 p8q <br /> 80 0 2 00 Payments -$188.98 p8q P43009.0, <br /> TOTAL $173.02 <br /> PRIOR STREET r1TV QT ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CONTINENTAL MUFFLER 209-368-1360 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 230 E LODI AVE LODI CA 95240 <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CONTINENTAL MUFFLER 209-368-1360 <br /> EMPLOYERSTREET qT 71P <br /> 230 E LODI AVE LODI CA 95240 <br /> PRFPARFn ay IDATE coL. 20 laieel <br />