Laserfiche WebLink
CPG # TO: -�FICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO. REFERRAL V <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> JOHN ROSSI HAY CO <br /> C/O NAME GUARANTOR SSN <br /> JOHN ROSSI <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> JOHN ROSSI HAY CO P.O. BOX 332 MANTECA CA 95336 209-823-3965 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> P.O. BOX 332 MANTECA CA 95336 209-823-3965 <br /> USER REFERENCE NO. JBILL TAT ICYCLE ISTATUS DATE BM CBMd INT MONTHLY PAYAMT P PROB <br /> 5977 HAZMAT 3/15/09 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> 11 11 1 non <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHkinARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 5 Chems @ $15.00 Each $75.00 <br /> 10% Late Charge $31.50 <br /> State Service Fee $24.00 <br /> Sm Hz Gen<5 Tons/yr $213.00 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $796.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> JOHN ROSSI HAY CO 209-823-3965 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 511 N AIRPORT WAY MANTECA CA 95336 <br /> SPOUS& CO—OWNER <br /> I.AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> JOHN ROSSI HAY CO 209-823-3965 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 511 N AIRPORT WAY MANTECA CA 9 336 <br /> PREPARED BY 4 oz CHECKED BY PATE 6 e o mL. 20(3M) <br />