Laserfiche WebLink
CPG # TO: &ICE OF REVENUE AND RECOVERY • <br /> ACCOUNT TRANSMITTAL Copy <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE T-­=AST AKA - FIRST MI TITLE <br /> KAISER PERMANENTE <br /> C/O NAME GUARANTOR SSN <br /> CORPORATE OFFICESKAIS�PERMANENTE <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> KAISER PERMANENTE 7373 N WEST LN STOCKTON CA 95210 209-467-3413 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> ORDWAY BLDG#1 KAISER PLAZA OAKLAND CA 94612 510-271-5910 <br /> USER REFERENCE NO. BILL STA CYCLE STATUS DATE BM CBMC INT MONTHLY PAY AMT <br /> 5526 HAZMAT <br /> 3/15/07 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START 7 STOP MED REC NO CHARGE <br /> CHARGE CHARGE <br /> NDESCRIPTION AMOUNT NQ DEPT.NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2007 Hmmp Annual Fee $70.00 <br /> 1 Chem @ $15.00 $15.00 <br /> 10% Late Charge $8.50 <br /> State Service Fee $24.00 <br /> Used Oil Only <5 Tons/yr $52.00 <br /> Permit Fee Penalty $52.00 <br /> TOTAL $221.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> KAISER PERMANENTE 209-467-3413 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1305 TOMMYDON ST STOCKTON CA 95210 <br /> 9PAT3&E CO-OWNER <br /> LAST FIRST MI TITLEJ SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> KAISER PERMANENTE 209-467-3413 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1305 TOMMYDON ST STOCKTON CA 95210 <br /> PREPARED BY CHECKED B <br /> DATE \ / CCL. 20 M8 <br />