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CPG # TO: "ICE OF REVENUE AND RECOVERY <br /> �.. ACCOUNT TRANSMITTAL i ACCOUNT NO. DEPT.NO. REFERRAL DAT COPY <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> BRICKYARD AUTOMOTIVE <br /> C/O NAME GUARANTOR SSN <br /> GREG LOOMIS <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 820 S BECKMAN RD 3BLODI CA 95240 209-473-152OHM <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 8820 RAVENWOOD DR STOCKTON CA 95209 209-473-1520 HM <br /> USER REFERENCE NO. BILL ST!j CYCLE STATUS DATE BMC CBMC INT I MONTHLY PAY AMT <br /> 12934 HAZMAT 3/15/08 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIEOB NT 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 /> NONO <br /> 230 026000.0 2008 Hmmp Annual Fee $240.00 <br /> 3 Chems @ $15.00 Each $45.00 <br /> 10% Late Charge $28.50 <br /> State Surcharge Fee $24.00 <br /> Sm Hw Gen <5tons/yr $213.00 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $763.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> BRICKYARD AUTOMOTIVE 209-473-152OHM <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 820 S BECKMAN RD 3B LODI CA 95240 <br /> GE49UM CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> BRICKYARD AUTOMOTIVE 209-473-152OHM <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 820 S BECKMAN RD 3B LODI CA 95240 <br /> PREPARED BYI CHECKED DAT ..7. /0 c COL 20 ranee <br /> kaV•�( .L L� TF• $� T/ J <br />