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CPG # TO: OWE OF REVENUE AND RECOVERY a 1� r-1nW ACCOUNT NO. •'�" DEPT.NO. '1'i(Ei1V �Ml'1'"1'HL "� " , 1 ' ___/ REFERRAL 026000.0 LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE U -STRIP IT INC C/O NAME GUARANTOR SSN SCOTT CATCHOT MAILING STREET CITY ST ZIP CODE AREA PHONE NO. 3175S HWY 99 W FRONTAGE RD STOCKTON CA 95215 209-948-8345 RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. 209-948-8345 USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBMd INd MONTHLY PAY AMT P 14485 HAZMAT 3/15/12 LAST - RECIPIENT - FIRST MI TITLE CIPIENT USER REFERENCE NO/NARRATIVE SERVICE DATE: STOP MED REG NO DATE OF CHARGE START CHARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT 230 042000.0 2012 Hazmat Fee $570.00 8q 1 P43009-01 301 1 042 900 0 Hazmat Penalty Fee $57.00 p8q 10 00 .0 p8q I q42YOOrO I Sm Hw Gen <5 Tons/yr $213.00 8q P4 009.0, p8q I 0I42q0010 I Permit Penalty Fee $0.00 8q 1 P43009.01 80 0 2 Q0010 I State Surcharge Fee $24.00 p8q 1 1 80 1 0 2 q0010 Electronic Surcharge Fee $25.00 843009-01 1 80 0 2 00. Payment -$262.00 8P43009.01 4 00 .0 TOTAL $627.00 GUARANTOR nnR DR I IC, NO PRIOR STREET CITY SI ZIP CODE EMPLOYER NAME EMPLOYER PHONE NO U -STRIP IT INC 209-948-8345 EMPLOYER STREET CITY ST ZIP CODE 3175 S HWY 99 W FRONTAGE RD STOCKTON CA 95215 AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO EMPLOYER NAME EMPLOYER PHONE NO U -STRIP IT INC 209-948-8345 EMPLOYER STREET CITY ZIE CODE 3175 S HWY 99 W FRONT E D �TO ON CA 95215 ____.___--- .//, _.0// ruvrircn cv InATF 1 COL 20 M'FR'