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CPG ., T0: CYCE OF REVENUE AND RECOVERY O �� <br /> TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> MANTECA EQUIPMENT RENTAL <br /> C/O NAME GUARANTOR SSN <br /> MANTECA EQUIP RENTAL <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 616 S MAIN ST MANTECA CA 95337 209-239-3507 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 616 S. MAIN ST. MANTECA CA 95337 209-239-3507 <br /> USER REFERENCE I BILL TAT CYCLE STATUS DATE BM CBM IN MONTHLY PAY AMT <br /> 968 HAZMAT <br /> 3/15/12 <br /> LAST - RECIPIENT - FIRST MI TITLE CIPIENT 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 042000.0 2012 Hazmat Fee $345.00 8 4 ,,E0 <br /> 30 042 000 Hazmat Penalty Fee $34.50 8VOO8 42 000 Sm Hw Gen <5 Tons/yr $213.00 88 0 2 000 Permit Fee Penalty $213.00 880 0 2 000 State Surcharge Fee $24.00 880 0 2 000 Electronic Surcharge Fee $25.00 880 0 2 00. 8 <br /> TOTAL 1 $854.50 <br /> nnpt <br /> PRIOR STREET ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NOI <br /> MANTECA EQUIPMENT RENTAL 209-239-3507 <br /> EMPLOYER STREET f <br /> ST ZIP CODE <br /> 616 S MAIN ST MANTECA CA 95337 <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I 1 <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> MANTECA EQUIPMENT RENTAL 209-239-3507 <br /> EMPLOYER STREET <br /> 616 S MAIN ST MANTEL �� CA 95337 <br /> . 1 CHECKED BY DATE .I COL. 20 (3/88) <br />