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# TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL Copy <br /> ACCOUNT NO. DEPT. NO REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> ORTON DEVELOPMENT INC <br /> C/O NAME GUARANTOR SSN <br /> EDDIE ORTON <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2716 E MINER AVE STOCKTON CA 95205-4705 510.669.0256 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3049 RESEARCH DR. RICHMOND CA 94806 510-758-7690 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATEI BM CEIMINTI MONTHLY PAY AMT TF <br /> PY PR <br /> 12407 HAZMAT 3/20/10 <br /> CHARGES <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 2010 Hazmat Fee $345.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $34.50 <br /> TOTAL $428.50 <br /> GUARANTOR <br /> DOBDR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ORTON DEVELOPMENT INC 510.669.0256 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2716 E MINER AVE STOCKTON CA 95205-4705 <br /> SPOUrN CO-OWNER <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 /> ORTON DEVELOPMENT INC 510.669.0256 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2716 E MINER AVE STOC T N CA 95205-4705 <br /> REPARED IS CHECKED BY ATE O coL zo 13ree1 <br />