Laserfiche WebLink
Cpg $ TO: OCE OF REVENUE AND RECOVERY • <br /> ACCOUNT TRANSMITTAL DATE COQ <br /> [py <br /> ACCOUNT NO. DPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> RAMIREZ AUTOMOTIVE <br /> C/O NAME GUARANTOR SSN <br /> JUAN RAMIREZ <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 811 N SACRAMENTO ST LODI CA 95240 209-367-4332 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 315 S STOCKTON ST LODI CA 95240 209-367-4385 <br /> USER REFERENCE NO. I BILLI STA CYCLE STATUS DATE BMd CBMC INT I MONTHLY PAY AMTDATE TERM nAM <br /> 6584 HAZMAT 1/24/05 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> DOB <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESC ON AMOUNT <br /> NO <br /> 230 026000.0 2005 Hmmp Annual Fee $240.00 <br /> 3 Chems @ $15.00 Each $45.00 <br /> 10% Late Charge $28.50 <br /> State Service Fee $24.00 <br /> Sm Hz Gen<5 Tons/yr $200.00 <br /> Permit Fee Penalty $200.00 <br /> TOTAL $737.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> RAMIREZ AUTOMOTIVE 209-367-4332 <br /> EMPLOYER STREET CITY STZIP CODE <br /> 811 N SACRAMENTO ST LODI CA 95240 <br /> OP960H CO—OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> RAMIREZ AUTOMOTIVE 209-367-4332 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 811 N SACRAMENTO ST LODI CA 95240 <br /> PREPARED B I CHECKED BY JDATE 9//,/,�g/OS coy 20 MW <br />