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»_. . ...::. ...: ....:. ............ <br /> CPG # TO: OI&E OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL ACCOUNT N0. DEPT.NO. REFERRALCopy <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> VALLEY TOWING PRODUCTS (CLOSED) <br /> C/O NAME GUARANTOR SSN <br /> RMP TOWING <br /> MAILING STREET CITY ST ZIPCODE AREA PHONE NO. <br /> VALLEY TOWING PRODUCTS (CLOSED) 31291 COMCAST DR NEW HAVEN MI 48048-2787 209-368-8881 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2250 THUNDERSTICK DR STE 1203 LEXINGTON KY 40505 859-294-5590 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM IN MONTHLY PAY AMT <br /> 3/15/12 <br /> 14402 HAZMAT <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NOMARRATIVE <br /> DOB <br /> SE VICE DATE DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARAffDESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION2302012 Hazmat Fee $420.00 8fi00 .030Hazmat Penalty Fee $42.00 88 42 00o State Surcharge Fee $24.00 88 0 2 000 Electronic Surcharge $25.00 880 0 2 000 8so o z o0o s 1 E4jso o z oo. s <br /> TOTAL $511.00 <br /> GUARANTOR <br /> PRIOR STREET ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHO NE NO <br /> VALLEY TOWING PRODUCTS(CLOSED) 209-368-8881 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1313 STOCKTON ST LODI CA 95240 <br /> AST4STOCKTONS <br /> FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EEMPLOYER PHONE NO <br /> VAODUCTS(CLOSED) 209-368-8881 <br /> EMP <br /> 131D ` CA 95240 <br /> ` - 1 CHECKED BY DATE COL. 20 (3M) <br />