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CPG # TO: 'FICE REVENUE AND RECOVERY O Ff <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNTNO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> A-1 TRUCK&TRAILER 1 11 11 1 <br /> C/O NAME GUARANTOR SSN <br /> KEVIN BLANKENSHIP <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 916 BROADWAY AVE STOCKTON CA 95205 209-942-3689 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1715 BRISTOL STOCKTON CA 95204 209-993-8004 <br /> USER REFERENCE NO, BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT PVMT <br /> 13038 HAZMAT 1.3/1,5/09 <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 CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> Nn <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 4 Chems @ $15.00 Each $60.00 <br /> 10% Late Charge $30.00 <br /> State Surcharge Fee $24.00 <br /> Sm Hw Gen <5 Tons/yr $213.00 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $780.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST 21P CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> A-1 TRUCK&TRAILER 209-942-3689 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 916 BROADWAY AVE STOCKTON CA 95205 <br /> S-PGUS9 CO—OWNER <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> A-1 TRUCK&TRAILER 209-942-3689 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 916 BROADWAY AVE STOCKTON CA 95205 <br /> REPARED BY CHECKED BYATE ` COI. 20(3M) <br /> �� I <br />