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CPG ,# TO: 06CE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL copy <br /> ACCOUNT N0. DEPT. NO. REFERRAL 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> CUSTOM METAL FINISHING <br /> C/O NAME GUARANTOR SSN <br /> NEIL DAVIS &TERRI TAYLOR <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1550 SHAW RD #CSTOCKTON CA 95215 209-505-0037 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 4212 ELDENBERRY CT MODESTO CA 95356 209-918-0815 <br /> PYMT PRO <br /> USER REFERENCE NO. BILL TAT ICYCLE STATUS DATE Bmd CBMd INT MONTHLY PAY AMT <br /> 9554 HAZMAT 3/15/12 <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> OR <br /> 1-4 <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT, NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 042000.0 2012 Hazmat Fee $360.00 <br /> 30 1 014290010 1 Hazmat Penalty Fee $36.00 <br /> p8q I q429OOrO I Gen 5<25 Tons Permit $1672.00 <br /> p8q o 2 00 I Permit Fee Penalty $1672.00 <br /> 80 1 0it2q0010 I State Surcharge Fee $24.00 <br /> 80 1 01,4290010 Electronic Surcharge Fee $25.00 <br /> Invoice #0223693 <br /> TOTAL $3789.00 <br /> GUARANTOR <br /> PRIOR STREET ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CUSTOM METAL FINISHING 209-505-0037 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1550 SHAW RD#C STOCKTON CA 95215 <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 /> CUSTOM METAL FINISHING 209-505-0037 <br /> EMPLOYER STREET CITY 1 <br /> 1550 SHAW RD C ST CK ON // I CA 1 95215 <br /> CHECKED BY IDATE coL. 20 (aiae� <br />