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CPG # TO: "-'FICE OF REVENUE AND RECOVERY <br /> �O ACCOUNT TRANSMITTAL tolpy <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> !AND7REW <br /> ST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> TRUCK SVC <br /> GUARANTOR SSN <br /> ALMERON SR <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> DOUBLE A TRUCK SVC P.O. BOX 1402 DISCOVERY BAY CA 94505 209-467-0873 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2301 FIRWOOD CT DISCOVERY CA 94505 925-634-5020 <br /> USER REFERENCE NO. BILL kTAT CYCLE STATUS DATE BMd CBMd INT MONTHLY PAY AMT PYMT PRO <br /> 8084HAZMATt T 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 /> CHKinARGE DEPT. NO. DESCRIPTION AMOUNT OHARGEJ DEPT. NO., DESCRIPTION AMOUNT <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 3 Chems @ $15.00 Each $45.00 <br /> 10% Late Charge $28.50 <br /> State Surcharge Fee $24.00 <br /> Sm Hw Gen <5tons/yr $213.00 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $763.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTOLIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> DOUBLE A TRUCK SVC 209-467-0873 <br /> EMPLOYER STREET CITYST ZIP CODE <br /> 1675 W CHARTER WAY#D STOCKTON CA 95206 <br /> SPA8S8 CO-OWNER <br /> ST FIRST MI TITLE SOC SEC NO. I DOB DR LIC NO AUTO LIC NO <br /> 1 <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> DOUBLE A TRUCK SVC 209-467-0873 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1675 W CHARTER WAY#D STOCKTON CA 95206 <br /> REPARED BY CHECKED BY ATE 6 //q COL M(3W <br />