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CPG 4 TO: 'ICE OF REVENUE AND RECOVERY COPY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO. REDATE FERRAL <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 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1030 LLOYD ST LODI CA 209-334-4316 <br /> USER REFERENCE NO. I BILL STA CYCLE STATUS DATE BM CBMC INT MONTHLY PAY AMT <br /> JF nAT TERM DATE <br /> 12934 HAZMAT 11/6/06 <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 /> NONO <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 /> TOTAL $330.00 <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 ZIP CODE <br /> 820 S BECKMAN RD 38 LODI CA 95240 <br /> SPebfSH 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 95240 <br /> PREPARED BY CHECKED B IDATE COL. 20 rv88 <br />