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BILLING_PRE 2019
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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MADRUGA
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1900 - Hazardous Materials Program
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PR0520771
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BILLING_PRE 2019
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Entry Properties
Last modified
3/23/2021 10:09:22 PM
Creation date
6/10/2018 12:27:26 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
BILLING
FileName_PostFix
PRE 2019
RECORD_ID
PR0520771
PE
1921
FACILITY_ID
FA0011239
FACILITY_NAME
XMGM OF CALIFORNIA
STREET_NUMBER
1044
Direction
(none)
STREET_NAME
MADRUGA
STREET_TYPE
RD
City
LATHROP
Zip
95330
APN
24141003
CURRENT_STATUS
Inactive, non-billable
SITE_LOCATION
1044 MADRUGA RD
P_LOCATION
(none)
P_DISTRICT
003
Supplemental fields
FilePath
\MIGRATIONS\M\MADRUGA\1044\PR0520771\BILLING.PDF
QuestysFileName
BILLING
QuestysRecordDate
7/14/2015 5:32:04 PM
QuestysRecordID
2799768
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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CPG if TO: TICE OF REVENUE AND RECOVERY �../ <br /> ACCOUNT TRANSMITTAL t ,^)'M <br /> ACCOUNT NO. DEPT. NO.t026000.0 <br /> REFMATP <br /> ERRAL C� © ' I 1IlliLAST - GUARANTOR - FIRSMI TITLE LAST - AKA - FIRST MI TITLE <br /> XMGM COMPANY <br /> C/O NAME GUARANTOR SSN <br /> RANDY SCHWOEBLE <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> XMGM COMPANY P.O. BOX 882 DOWNERS GROVE IL 60515-0882 209-858-0283 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 6464 W. 51ST STREET FOREST VIEW IL 60638 773-908-9370 <br /> USER REFERENCE NO. BILL TATF <br /> STATUS DATE BM CBM INT MONTHLY PAY AMT <br /> VMT PRO11 <br /> 9510 HAZMAT I I I I I <br /> 3/15/09 <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 /> Kin 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 2 Chems @ $15.00 Each $30.00 <br /> 10% Late Charge $27.00 <br /> State Surcharge Fee $24.00 <br /> TOTAL $321.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> XMGM COMPANY 209-858-0283 <br /> EMPLOYER STREET CITY I ST ZIP CODE <br /> 1044 MADRUGA RD LATHROP CA 95330 <br /> SPOUSE- CO—OWNER <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NOAUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> XMGM COMPANY 209-858-0283 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1044 MADRUGA RD LATHROP CA 95!301 <br /> REPARED BY 54CHECKED BYDATE /z D� cOL. 20 13M) <br /> Z /7 <br />
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