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CPG # TO: OFFICE OF REVENUE AND RECOVERY COPY <br /> ACCOUNT TRANSMITTAL �..i <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> ALL PRO PERFORMANCE (CLOSED) <br /> C/O NAME GUARANTOR SSN <br /> RUBEN RUBALCAVA <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> ALL PRO PERFORMANCE (CLOSED)820 S CALIFORNIA ST A STOCKTON CA 95206 209-507-2799 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1822 NIGHTINGALE AVE STOCKTON CA 95205 209-507-2799 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT PYMT PR <br /> OB 11 <br /> 14153 HAZMAT 3/20/11 <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 Kin DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2011 Hazmat Fee $100.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $10.00 <br /> TOTAL $159.00 <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 /> ALL PRO PERFORMANCE (CLOSED) 209-507-2799 <br /> EMPLOYER STREET CITY ST I ZIP CODE <br /> 820 S AMERICAN ST STOCKTON CA 95206 <br /> S-POUS& CO-OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ALL PRO PERFORMANCE (CLOSED) 209-507-2799 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 820 S AMERICAN ST STOCKT CA 95205 <br /> PREPARED BY CHECKED BY DATE COL. 20 Feel <br />