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CPG # TO: O,y�CE OF REVENUE AND RECOVERY COPY TRANSMITTAL, <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> JF DONALDSON <br /> C/O NAME GUARANTOR SSN <br /> JFD RETYRE INC <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 240 N HUNTER ST STOCKTON CA 95202 209-466-4393 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 209-466-4393 <br /> USER REFERENCE NO. BILL kTAT CYCLE STATUS DATE BMd CBM IN MONTHLY PAY AMT <br /> 3329 HAZMAT 3/15/12 <br /> LAST - RECIPIENT - FIRST MI TITLE CIPIENT USER REFERENCENO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> STAT STOP I <br /> MED REC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> 230 042000.0 2012 Hazmat Fee $100.00 8043009-0, <br /> 30 0142900 0 Hazmat Penalty Fee $10.00 8 104300P.01 <br /> 8q42900,0 Sm Hw Gen <5 Tons/yr $213.00 8P43009.01 <br /> 8 014290010 Permit Fee Penalty $213.00 8043009.01 <br /> 80 0 2 00 0 State Surcharge Fee $24.00 8 a oo .0 <br /> 80 0 2 00 0 Electronic Surcharge Fee $25.00 8043009.0 <br /> ;8# <br /> 8 400 .0 <br /> TOTAL $585.00 <br /> DOR DR I 1G,No <br /> PRIOR STREET . <br /> ?IPC,ODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> JF DONALDSON 209-466-4393 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 240 N HUNTER ST STOCKTON CA 95202 <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> JF DONALDSON 209-466-4393 <br /> EMPLOYER STREET <br /> 240 N HUNTER ST STOCKY CA 95202 <br /> i C ECKED B DAT cot. <br /> 2o Ia�eel <br />