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CPG.# TO: Of :E OF REVENUE AND RECOVERY TRANSMITTALACCOUNT NO. EPT.NO. REFERRAL copy <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> PRECISION SAMPLING INC <br /> C/O NAME GUARANTOR SSN <br /> PRECISION SAMPLING INC <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2365 WIGWAM DR STOCKTON CA 95205 209-465-8712 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3474 FOUR DENTELL CTR, P.O. BOX 492241055 VANCOUVER BC V7X-11-2 604-669-3373 <br /> USER REFERENCE NO. BILL kTAT CYCLE STATUS DATE BMd CBMd IN MONTHLY PAY AMT <br /> 13580 HAZMAT 3/15/12 <br /> LAST - RECIPIENT - FIRST MI TITLE -IZPCIPIENT USER REFERENCE NO/NARRATIVE <br /> r <br /> RVICE DA DATE OF <br /> STOP MED REC NO CHARGE <br /> DEPT.NO. DESCRIPTION AMOUNT RCHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> 042000.0 2012 Hazmat Fee $300.00 4 00 .0 042 000 Hazmat Penalty Fee $30.00 04 00 .0 42 000 Sm Hw Gen <5 Tons/yr $213.00 4 00 .0 0 2 00 0 Permit Fee Penalty $213.00 1 P43009.01 <br /> 8 0 2 0010 1 State Surcharge Fee $24.00 1 p8q <br /> 1 Il <br /> 80 11 o 2 o0 0 Electronic Surcharge Fee $25.00 p8q P43009.0, <br /> 8 002qOO.p p8q400 .0 <br /> TOTAL $805.00 <br /> QTARANTOR <br /> PRIOR STREET r.ITV ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> PRECISION SAMPLING INC 209-465-8712 <br /> EMPLOYER STREET CITY T ZIP CODE <br /> 2365 WIGWAM DR STOCKTON CA 95205 <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 /> PRECISION SAMPLING INC 1 209-465-8712 <br /> EMPLOYER STREET CITY QT 71P COnr <br /> 2365 WIGWAM DR T KT CA 95205 <br /> PRFPARFQ CHECKED BY COC 20 heel <br />