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CPG # _ TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL COPY <br /> ACCOUNT NO. DEPT, NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> VALLEY TOWING PRODUCTS <br /> C/O NAME GUARANTOR SSN <br /> RMP TOWING <br /> MAILING STREET CITY ST ZIPCODE AREA PHONENO. <br /> 1300E VINE ST #3&#4LODI CA 95240 209-368-8881 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2250 THUNDERSTICK DR STE 1203 LEXINGTON KY 40505 859-294-5590 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BMd CBMd INT MONTHLY PAY AMT PYMT PROBI <br /> 14403 HAZMAT <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 /> Kin <br /> 230 026000.0 2010 Hazmat Fee $85.00 <br /> Hazmat Penalty Fee $8.50 <br /> TOTAL $93.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITYST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> VALLEY TOWING PRODUCTS 209-368-8881 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1300 E VINE ST#3& #4 LODI CA 95240 <br /> SPOUfig CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> VALLEY TOWING PRODUCTS 209-368-8881 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1300 E VINE ST#3&#4 LODI CA 95240 <br /> PREPARED BY CHECKED BV DATE Id .,2 /C coL. zU(I"..) <br />