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jPG*.# TO: O^FICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL • C O Fo)y <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> OAKRIDGE WAREHOUSES (CLOSED) <br /> C/O NAME GUARANTOR SSN <br /> TRISH O'DANIEL <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> OAKRIDGE WAREHOUSES (CLOSED) P.O. BOX 1823 OAKDALE CA 95361 209-735-1194 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> P.O. BOX 1823 OAKDALE CA 95361 209-735-1194 <br /> USER REFERENCE NO. BILL TAT CYCLE STDATE BM CBM INT MONTHLY PAY AMT PROS <br /> 13978 HAZMAT 4/15/11 <br /> STATUS <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 HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 042000.0 2011 Hazmat Fee $85.00 380 042000.0 <br /> 230 042000.0 Haz Mat Penalty Fee $8.50 380 042000.0 <br /> 380 042000.0 380 042000.0 <br /> 380 042000.0 380 042000.0 <br /> 380 042000.0 State Surcharge Fee $24.00 380 042000.0 L-v <br /> 380 042000.0Electronic Surcharge Fee $25.00 380 042000.0 <br /> 380 042000.0 380 042000.0 <br /> TOTAL $142.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO I.IC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> OAKRIDGE WAREHOUSES (CLOSED) 209-735-1194 <br /> EMPLOYER STREET CITY ii: ZIP CODE <br /> 1604 TILLIE LEWIS OR STOCKTON CA 95206 <br /> CO-OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> OAKRIDGE WAREHOUSES(CLOSED) 209-735-1194 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1604 TILLIE LEWIS DR STO ON CA 95206 <br /> REPARED BY CHECKED B DATE 7 a0-� COL. 20 (31W) <br />