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CPG #' TO: 'ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL COPY <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> THANH AUTO REPAIR <br /> C/O NAME GUARANTOR SSN <br /> MARK HA 1 11 <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1402 BOURBON ST STOCKTON CA 95204 209-943-6322 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 5504 RAYANNA DR STOCKTON CA 95212 209-478-2438 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BMd CBMd INT MONTHLY PAY AMT I 77PRAT� <br /> 13887 HAZMAT 7/15/09 <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 CHARGEKin DEPT, NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2006 - 2009 Annual <br /> Hmmp Fee $280.00 <br /> 3 Chems @ $15.00 <br /> Each Year $180.00 <br /> 10% Late Charge $46.00 LWill ' <br /> TOTAL $506.00 <br /> GUARANTOR <br /> DOB DR LIC NO----F AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> THANH AUTO REPAIR 209-943-6322 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1402 BOURBON ST STOCKTON CA 95204 <br /> S-PAi-J-Sr!,- CO-OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAMEI I <br /> EMPLOYER PHONE NO <br /> THANH AUTO REPAIR 209-943-6322 <br /> EMPLOYER STREET CI Y ST ZIP CODE <br /> 1402 BOURBON ST STOCKTON 0 CA 95204 <br /> REPARED B 2 1 CHECKED BY 4 JDATE COQ. zo (aael <br />