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CPG # TO: "FILE OF REVENUE AND RECOVERY <br /> f.. ACCOUNT TRANSMITTAL //l(\v_� O Fl <br /> yACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> OFF ROAD ENTERPRISES <br /> C/O NAME GUARANTORISSN <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 NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT B <br /> QATP <br /> 6985 HAZMAT I 1 11 11 1 1 1 1 1 1 1 1 1 1 1 1.3/1 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 3 Chems 9 $15.00 Each $45.00 <br /> 10% Late Charge $28.50 <br /> State Service Fee $24.00 <br /> Sm Hw Gen<5 Tons/yr $213.00 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $763.50 <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 /> SAGVFS& CO-OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> 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 AVE#B STOCKTON CA 95215-2233 <br /> PREPARED BY CHECKED BY JDATE /JO �� COL. 20 (3RB) <br /> c� N <br />