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SPG # T0: 0`"' CE OF REVENUE AND RECOVERY 6 ACCOUNT TRANSMITTAL COPY <br /> ACCOUNT NO. DEPT,NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> D.A.ARCHER EXCAVATING <br /> C/O NAME GUARANTOR SSN <br /> DAVID A ARCHER JR <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> D.A.ARCHER EXCAVATING 5948 E WATERLOO RD STOCKTON CA 95215 209-601-3745 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 5948 E.WATERLOO ROAD STOCKTON CA 95215 209-601-3745 <br /> RU <br /> USER REFERENCE NO. BILL TAT ICYCLE ISTATUS DATEI BMd CBMd IN MONTHLY PAY AMT <br /> 13269 HAZMAT 1.3/1 <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> WR <br /> SERVICE 6ATEl DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> NR 230 042000.0 2012 Hazmat Fee $345.00 8 4 00 .o <br /> 30 1 042 00 o I Hazmat Penalty Fee $34.50 p8q P4300P.0 <br /> 6 42 00 0 State Surcharge Fee $24.00 p8q 1 P43009-01 <br /> p8q I 0 2 00 o I Electronic Surcharge $25.00 p8q 1 P43009-01 <br /> 80 04220010 P44009.0 <br /> 80 0 2 00 0 8 4 00 .0 <br /> 80 0 2 00. Sq P43009.0, <br /> TOTAL $428.50 <br /> GUARANTOR <br /> PRIOR STREET r= RT ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> D.A. ARCHER EXCAVATING 209-601-3745 <br /> EMPLOYER STREET CITY ST I ZIP CODE <br /> 775 SECOND ST STOCKTON CA 95206 <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> 1 I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> D.A.ARCHER EXCAVATING 209-601-3745 <br /> EMPLOYER STREET CITY ST 71P(',ODF <br /> 775 SECOND ST ST9C TON I CA 95206 <br /> ECKED BY IDATECOL. 20 MISS, <br />