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CYG TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL COPY ACCOUNT NO. DEPT. N� REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST <br /> MI TITLE <br /> OFF ROAD ENTERPRISES <br /> C/O NAME GUARANTOR SSN <br /> WADE MARTIN <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2953 CHERRYLAND AVE #BSTOCKTON CA 95215-2233 209-931-1170 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3261 CHERRYLAND AVE. STOCKTON CA 95215 (209)969-7178 <br /> USER REFERENCE I E BILL TAT CYCLE STATUS DABM CBM INT MONTHLY PAY AMT MT PRO <br /> 6985 ETE <br /> 3/20/10 <br /> RCHAR=GESLAST - RECIPIENT - FIRST FERENCE NO/NARRATIVE <br /> SERVICE DATE:START STOP MED REC NO <br /> CHKinARGE DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 Sm Hw Gen <5tons/yr $213.00 <br /> 2010 Hazmat Fee $285.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge Fee $25.00 <br /> Hazmat Penalty Fee $28.50 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $788.50 <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 /> OFF ROAD ENTERPRISES 209-931-1170 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2953 CHERRYLAND AVE#B STOCKTON CA 95215-2233 <br /> SgAHSE- CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. I DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> OFF ROAD ENTERPRISES 209-931-1170 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2953 CHERRYLAND VE 6OPLKTON CA 95215-2233 <br /> REPARED BY CHECKED BY DATE -� -7 p col. zo (s�ae) <br />