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CPG # TO: O CE OF REVENUE AND RECOVERY ! Copy ACCOUNT TRANSMITTALACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> C DEJONG TRUCKING INC <br /> C/O NAME GUARANTOR SSN <br /> DEJONG TRUCKING <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> C DEJONG TRUCKING INC P.O.BOX 126 RIPON CA 95366 209-599-4187 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONENO. <br /> P.O. BOX 126 RIPON CA 95366 209-599-4187 <br /> USER REFERENCE NO. BILL STAI CYCLE STATUS DATE BMC CBMC INT MONTHLY PAY AMT <br /> IF CAT TERM DATE <br /> 3174 HAZMAT 4/15/06 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> nnR <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE <br /> NO DEPT.NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2006 Hmmp Annual Fee $240.00 <br /> 4 Chems @ $15.00 Each $60.00 '" <br /> 10% Late Charge $30.00 ` =, <br /> State Service Fee $24.00 a <br /> Sm Hw Gen <5 Tons $200.00 <br /> Permit Fee Penalty <br /> Paid - 5/8/06 <br /> TOTAL :::::::[7$554-00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> C DEJONG TRUCKING INC 209-599-4187 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 24975 S AUSTIN RD RIPON CA 95366 <br /> SPeU&B CO—OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> C DEJONG TRUCKING INC 209-599-4187 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 24975 S AUSTIN RD RIPON CA 95366 <br /> PREPARED BYE CHECKED BY JDATE 2 0 CCL. zo lees <br />