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CPC # TO: 'ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL p <br /> MACCOUNT NO. DEPT.NO. REFERRAL U <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> FARIAS AUTO REPAIR <br /> C/O NAME GUARANTOR SSN <br /> JOSE FARIAS <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> FARIAS AUTO REPAIR P.O. BOX 5875 STOCKTON CA 95205-0875 209-570-2081 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1823 CHEROKEE ROAD SPC.#1 STOCKTON CA 95205 209-570-2081 <br /> USER REFERENCE NO. BILL STA CYCLE STATUS DATE BM CBMC INT MONTHLY PAY AMT <br /> 10513 HAZMAT 3/15/07 <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 /> NONO <br /> 230 026000.0 2007 Hmmp Annual Fee $70.00 <br /> 2 Chems @ $15.00 Each $30.00 <br /> 10% Late Charge $10.00 <br /> State Surcharge Fee $24.00 <br /> Sm Hw Gen <5 Tons/yr $206.00 n 9 is <br /> Permit Fee Penalty $206.00 <br /> TOTAL $546.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> FARIAS AUTO REPAIR 209-570-2081 <br /> EMPLOYER STREET CITY zlp ODE <br /> 2029 E CHEROKEE RD STOCKTON CA 95205 <br /> SPA89H CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> FARIAS AUTO REPAIR 209-570-2081 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2029 E CHEROKEE RD STOCKTON CA 95205 <br /> PREPARED BYCHECKED B DATE 7a �� coL. 20 �aaa <br />