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CPG # TO: "ICE OF REVENUE AND RECOVERY <br /> C <br /> .,,, O PY <br /> ACCOUNT TRANSMITTAL .s <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> DELTA SPEEDWAY <br /> C/O NAME GUARANTOR SSN <br /> KIM EVANS <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> DELTA SPEEDWAY 17333 N COMCONEX RD MANTECA CA 95336 209-481-3442 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 891 MONTICELLO LANE MANTECA CA 95336 209-481-3442 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT M B <br /> 13518 HAZMAT 12/15/08 <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 /> 230 026000.0 2003 - 2008 Hmmp <br /> Annual Fee $1440.00 <br /> 1 Chem @ $15.00 <br /> Each Year $90.00 <br /> 10% Late Charge $153.00 <br /> TOTAL 1 $1683.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> DELTA SPEEDWAY 209-481-3442 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1658 S AIRPORT WAY STOCKTON CA 95206 <br /> S-PGN,SF, CO—OWNER <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> DELTA SPEEDWAY 209-481-3442 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1658 S AIRPORT WAY STOCKTON CA 1 95206 <br /> PREPARED BY I CHECKE BYDATE q COL. 20 (3188) <br /> v <br /> / Z� �l <br />