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CPG # TO: �FICE OF REVENUE AND RECOVERY I-I00 COPY <br /> ACCOUNT TRANSMITTALACCOUNT NO. DEPT.NO. REFERRAL <br /> DATE <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> PRODUCTION CAR CARE PROD(1015) <br /> C/O NAME GUARANTOR SSN <br /> LEWYN BOILER <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> PRODUCTION CAR CARE PROD(1015) 1000 E CHANNEL ST STOCKTON CA 95205 209-483-2454 <br /> RESIDENCE STREET CITY ST ZIPCODE AREA PHONE NO. <br /> 1000 E.CHANNEL ST. STOCKTON CA 95205 209-943-7337/ <br /> USER REFERENCE NO. BILL STAI CYCLE STATUS DATE BM CBMC INT I MONTHLY PAY AMT <br /> DATE TERMUDEATE <br /> 1313 HAZMAT 3/15/08 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> nnRSERVICE DATE: DATE OF <br /> START STOPMED REC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> NONO <br /> 230 026000.0 2008 Hmmp Annual Fee $240.00 <br /> 30 Chems @ $15.00 $450.00 <br /> 10% Late Charge $69.00 {y <br /> State Surcharge Fee $24.00 <br /> it- <br /> TOTAL $783.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> PRODUCTION CAR CARE PROD(1015) 209-483-2454 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1015E CHANNEL ST STOCKTON CA 95205 <br /> CO—OWNER <br /> LAST FIRSTMI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> PRODUCTION CAR CARE PROD(1015) 209-483-2454 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1015 E CHANNEL ST STOCKTOCq 95205 <br /> PREPARED BY T CHECKED BY DATE 3� coy. 20 lase <br /> L <br />