Laserfiche WebLink
CPG.# - _ TO: OFFICE REVENUE AND RECOVERY - COPYACCC OUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO. REFER ...� <br /> 026000.0 RAL <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> ULLOA'S TOW&AUTO REPAIR <br /> C/O NAME GUARANTOR SSN <br /> ULLOA'S TOW&AUTO REPAIR <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 620 S WILSON WAY STE CSTOCKTON CA 95205 209-943-0588 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 209-943-0588 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BMd CBMd INT MONTHLY PAYAMT <br /> �wA DAX-F- <br /> 12529 HAZMAT 3/15/12 <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> -4-44-4-- <br /> SERVICE DATE' DATE OF <br /> TART STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> PIR M9 <br /> 230 042000.0 2012 Hazmat Fee $100.00 8q 04300p.0 <br /> 30 1 114290010 1 Hazmat Penalty Fee $10.00 31q 0400 .0 <br /> 8 42 00 o State Surcharge Fee $24.00 38q <br /> �8q 1 04290010 Electronic Surcharge $25.00 38q <br /> 80 11 0 290010 8P43009.0 t 11 <br /> 80 1 0 290010 89 043009.0 <br /> 80 1 0 2qOO,p I 38q4 00 .0 <br /> TOTAL $159.00 <br /> GUARANTOR <br /> PRIOR STREET rITY qT ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ULLOA'S TOW&AUTO REPAIR 209-943-0588 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 620 S WILSON WAY STE C 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 /> ULLOA'S TOW&AUTO REPAIR 209-943-0588 <br /> EMPLOYER STREET CITY ;T 71P QQQE <br /> 620 S WILSON WAYS C ST CKTON CA 95205 <br /> , <br /> I��G CHECKED BY IDATE COL. zo laiae> <br />