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CPG'# TO: OFFICE OF REVENUE AND RECOVERY COPY ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. MT71; <br /> LAST - GUARANTOR - FIRSLAST - AKA - FIRST MI TITLE <br /> OAKLAND BAGSC/O NAMEOR SSN <br /> OAKLAND BAGS INC <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 635 S AURORA ST STOCKTON CA 95203 209-467-0188 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAV AMT <br /> PYM Hub <br /> 13824 HAZMAT I 1 1 3/20/10 <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 HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 Sm Hw Gen<5tons/yr $213.00 <br /> 2010 Hazmat Fee $330.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge Fee $25.00 <br /> Hazmat Penalty Fee $33.00 <br /> =Permit Penalty $213.00 <br /> TOTAL $838.00 <br /> GUARANTOR <br /> D!L, DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> 1 F <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> OAKLAND BAGS 209-467-0188 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 635 S AURORA ST STOCKTON CA 95203 <br /> S-POUS& CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> 1 I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> OAKLAND BAGS 209-467-0188 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 635 S AURORAS TO T, CA 95203 <br /> PREPARED BY CHECKED BY DATE a j'-�U GOA. 20 13re31 <br />