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CPG # TO: 'VICE OF REVENUE AND RECOVERY <br /> %. ACCOUNT TRANSMITTAL ... <br /> ACCOUNT NO. DEPT. NO. REFERRAL COPY 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> GOLDEN LUBRICANTS CORP <br /> C/O NAME GUARANTOR SSN <br /> LOC TOM NGO <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> GOLDEN LUBRICANTS CORP 915 N BROADWAY AVE STOCKTON CA 95205 510-418-2444 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2328 CANADA GOOSE CT STOCKTON CA 95757 510-418-2444 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATEI BM CBM INT MONTHLY PAY AMT I PY�.l PR B <br /> 12578 HAZMAT 1.3/15/09 <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 HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> Nn <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 2 Chems @ $15.00 Each $30.00 <br /> 10% Late Charge $27.00 <br /> State Surcharge Fee $24.00 <br /> E1111111 <br /> TOTAL $321.00 <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 /> GOLDEN LUBRICANTS CORP 510-418-2444 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 915 N BROADWAY AVE STOCKTON CA 95205 <br /> SPOUS& CO—OWNER <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> GOLDEN LUBRICANTS CORP 510-418-2444 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 915 N BROADWAY AVE STOCKTON CA 9 205 <br /> REPARED BY CHECKED BY JDATE ?t�' 6 CI COL. n (3W) <br />