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CPG # TO: 0'NOW,�E OF REVENUE AND RECOVERY <br /> TRANSMITTAL O <br /> CPY <br /> ACCOUNT NO. DE NO. REFERRAL <br /> 026000.0 <br /> LAST GUARANTOR FIRST Mi TITLE LAST AKA FIRST MI TITLE <br /> FAVORITE CLEANERS <br /> C/O NAME GUARANTOR SSN <br /> SI YOP HONG I )DE AREA PHONE NO <br /> MAILING STREET riTy ST ZIP <br /> 622 E CHARTER WAY STOCKTON CA 95206 209-463-3374 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1324 BUCKINGHAM WAY#70 STOCKTON CA 95207 209-463-3874 <br /> USER REFERENCE NO. BILLTATC <br /> YCLEI STATUS DATE BM <br /> CBM IN MONTHLY PAY AMT <br /> 982 HAZ, 6 <br /> 3/15/12 <br /> I <br /> WgR�CIPI=ENT �1 ---�--=., <br /> LAST - RECIPIENT - FIRST MI TITLE = USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> CHARGE DEPT. NO. DESCRIPTION NT <br /> 230 042000.0 2012 Hazmat Fee $255.00 �8q 1 P43009-01 1 <br /> 30 1 0142900 10 1 Hazmat Penalty Fee $25.50 P89 1 104300P.0 1 1 <br /> �8q I q42900rO Sm Hw Gen <5 Tons/yr $213.00 p8q 1 P43009.01 1 <br /> rP q 1 0142 0010 Permit Fee Penalty $213.00 8q 1 P43009.01 1 <br /> �801 h0 2 0010 1 State Surcharge Fee $24.00 p8q P4 00 .o 1, <br /> ?801 11 02q00j0 i Electronic Surcharge Fee $25.00 Bq P43009.0, 11 — <br /> Pol 11 O 2400,0 38q P43 09-01 11 <br /> TOTAL $755.50 <br /> GUARANTOR <br /> nOR np I Z�—�l ITO I <br /> PRIOR STREET .1TV 9T:I—ZIP F—CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO� <br /> FAVORITE CLEANERS 209-463-3874 <br /> EMPLOYER STREET CITY STZIP �q <br /> CODE <br /> 622 E CHARTER WAY STOCKTON CA 95206 <br /> AST FIRST Mi TITLEI SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> FAVORITE CLEANERS 209-463-3874 <br /> EMPLOYERSTREET CITY �T 71P r.()nF <br /> 622 E CHARTER�WAY T PN CA 95206 <br /> PREPARED R -----FCHECKED BY [DATE I COL 20 rl'Mll <br />