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`CP z TO: ICE OF REVENUE AND <br /> j t <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT.NO, REFERRALFE <br /> 026000.0 CoIr <br /> LAST -GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST <br /> - MI TITLE <br /> D.H.WINN TRUCKING <br /> C/O NAME GUARANTOR SSN <br /> DOUGLAS H WINN <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> D.H.WINN TRUCKING P.O. BOX 400 LOCKEFORD CA 95237 209-727-5608 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> RUSSELL WiNN114711 E.JUNIPER AVE LOCKEFORD CA 95237 209-:727-5608 <br /> USER REFERENCE NO. BILLI STA CYCLEI STATUS DATE BMC CBMC INT MONTHLY PAY AMT <br /> 13264 HAZMAT <br /> 3/15/08 <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 <br /> NO DEPT.NO. DESCRIPTION AMOUNT " CHARGE DEPT.NO.. DESCRIPTION AMOUNT <br /> 230 026000:0 2008 Hmmp Annual Fee. $240.00 <br /> 6 Chems @ $15.00 Each $90.00 " <br /> 10% Late Charge $33.00 <br /> State Surcharge Fee $24.00 <br /> Sm Hw Gen <5tons/yr $213.00 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $813.00 r <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> . i <br /> PRIOR STREET CITY ST. ZIP CODEI I I -I I I. I I I I ( 'I ] a k <br /> " II <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> D.H.WINN TRUCKING 209-727-5608 <br /> EMPLOYER STREETCITY ST ZIP CODE ` <br /> r <br /> 12505 E BRANDT RD LOCKEFORD CA 95237 <br /> SPEWS—B CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC:NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> i <br /> Q.H.WINN TRUCKING 209-727-5608 <br /> EMPLOYER STREET CITY ii ST ZIP CODE <br /> 12505 E BRANDT RD LOCKEFO 'I CA 95237 <br /> PREPARED B ICHECKED 13YI A COL. 20 (3/88 <br />