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CPG # TO: . -�FICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL �L C <br /> O IFY <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> FARIAS AUTO REPAIR 1 11 11 11 L <br /> C/O NAME GUARANTOR SSN <br /> JOSE FARIAS <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2029 E CHEROKEE RD STOCKTON CA 95205 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 TAT CYCLE STATUS DATEI BMd CBM INT MONTHLY PAY AMT P B <br /> 10513 HAZMAT 3/15/09 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NOINARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT, NO. DESCRIPTION AMOUNT <br /> mn <br /> 230 026000.0 2009 Hmmp Annual Fee $70.00 <br /> 2 Chems @ $15.00 Each $30.00 <br /> 10% Late Charge $10.00inn <br /> State Surcharge Fee $24.00 4 <br /> Sm Hw Gen<5 Tons/yr $213.00 <br /> Permit Fee Penalty $213.00 ±--�-� <br /> 46�AL $560.00 <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 ST ZIP CODE <br /> 2029 E CHEROKEE RD STOCKTON CA 95205 <br /> SPQU98 CO-OWNER <br /> AST FIRST MI TITLE SOC SEC NO. I DOB DR LIC NO I AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> FARIAS AUTO REPAIR 209-570-2081 <br /> EMPLOYER STREET CITY I ST I ZIP CODE <br /> 2029 ECHEROKEE RD STOCKTON CA 1 95205 <br /> REPARED BY ' CHECKED BY ATE / COL 20 (peel <br /> F e <br />