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CPO # TO: ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL C <br /> OP <br /> {� <br /> ACCOUNT NO. DEPT.NO. I DATE <br /> REFERR <br /> 026000.0 AL V <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 33LODI CA 95240 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1030 LLOYD ST LODI CA 209-334-4316 <br /> USER REFERENCE NO. I BILLI STA CYCLE STATUS DATE BMC] CBMCJ INT MONTHLY PAY AMT <br /> IF QAT TERM DATE <br /> 12934 HAZMAT 3/15/07 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> OR <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.o 2007 Hmmp Annual Fee $240.00 <br /> 4 Chems @ $15.00 Each $60.00 <br /> 10% Late Charge $30.00 <br /> State Surcharge Fee $24.00 <br /> Sm Hw Gen <5tons/yr $206.00 <br /> Permit Fee Penalty $206.00 <br /> TOTAL $766.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> BRICKYARD AUTOMOTIVE <br /> EMPLOYER STREET CITY ST ZIPCODE <br /> 820 S BECKMAN RD 3B LODI CA 95240 <br /> SPeU-5B 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 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 820 S BECKMAN RD 3B LODI CA 1 95240 <br /> PREPARED BYE / CHECKED BY DATE �� COL. 20 lyes <br />