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CPG # TO: OFFICE REVENUE AND RECOVERY COPY <br /> ACCOUNT TRANSMITTAL <br /> DEPT. NO <br /> ACCOUNT NO. REFERRAL �.rC <br /> . <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> FREIH'S AUTO REPAIR 11 1 j 11 <br /> C/O NAME GUARANTOR SSN <br /> CURTIS FREIH <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 916 BLACK DIAMOND WAY #BLODI CA 95240 209-368-5689 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 209-368-5689 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BMCBM INT MONTHLY PAY AMT PYMT PR <br /> 938HAZMAT 3/20/10 <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 CHARG EML DESCRIPTION AMOUNT <br /> NO <br /> 230 026000.0 2010 Hazmat Fee $100.00 <br /> Sm Hw Gen <5tons/yr $213.00 r <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge Fee $25.00 v <br /> Correction -$213.00 L 1 <br /> Hazmat Fee Penalty $10.00 <br /> Payments -$106.00 <br /> ! ,, TAL $53.00 <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 /> FREIH'S AUTO REPAIR 209-368-5689 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 916 BLACK DIAMOND WAY#B LODI CA 95240 <br /> SPARSE- CO-OWNER <br /> AST FIRST MI TITLE SOC SEC NO. I DOB DR LIC NO I AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> FREIH'S AUTO REPAIR 209-368-5689 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 916 BLACK DIAMOND WAY#B ODI Cq 95240 <br /> REPARED BY CHECKED BY DATE r.- 7 /-/Cc0L. 20 Bias) <br />