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CPG v_` TO:, i CE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT.NO. REFERRALDATE <br /> COPY <br /> 026000.0 <br /> LAST - GUARANTOR FIRST MI TITLE LAST - AKA FIRST MI TITLE <br /> D.H.WINN TRUCKING <br /> CIO 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 .r 209-727-5608 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO, <br /> RUSSELL WINN/14711 E.JUNIPER AVE LOCKEFORD CA 95237 209-727-5608 <br /> USER REFERENCE NO. BILL STA CYCLE STATUS DATE BM CBMC INT MONTHLY PAY AMT DUE QATF TFRIVI DATE <br /> 13264 HAZMAT } 12/15/07 <br /> CHARGES _ <br /> LAST - RECIPIENT FIRST MI TITLE RECIPIENTDOR 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 2007 Hmmp Annual Fee $240.00 <br /> 6 Chems @ $15.00 Each $90:00" <br /> 10% Late Charge $33.00 <br /> f <br /> TOTAL. $363.00 : <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> D.H.WINN TRUCKING 209-727-6608 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 12505 E BRANDT RD LOCKEFORO CA 95237" <br /> SFERSE CO-OWNER . <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE-NO <br /> D.N.WINN TRUCKING <br /> 209-727-5608' <br /> EMPLOYER STREET CITY ST ZIP CODE <br />{ 12505 E BRANDT RD LOCKEFOR CA 95237 <br /> PREPARED B CHECKED8Y I' QATE �- aa-" COL. 26 (3X88 <br />