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r-P <br /> E OF <br /> CPG # TO. IC <br /> 1. ACCOUNTREVENUE RECOVERY <br /> TRANSMITTALIm/ OP <br /> � <br /> ACCOUNT NO. DEPT. NO. REFERRAL V <br /> n�Tc C <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> GILLS SMOG CHECK <br /> C/O NAME GUARANTOR SSN <br /> BAGGA SINGH <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> GILLS SMOG CHECK 7777 S BATES RD TRACY CA 209-346-4318 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 7777 BATES RD TRACY CA 209-836-1489 <br /> PRnff— <br /> USER REFERENCE NO. IBILL TAT ICYCLE ISTATUS DATE BM CBM INT MONTHLY PAY AMT I PYMT <br /> 13574 HAZMAT 11/15/09 <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 /> CHARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> mr)230 026000.0 2008 - 2009 Hmmp <br /> Annual Fee $140.00 <br /> 1 Chem @ $15.00 <br /> Each Year $30.00 <br /> 10% Late Charge $17.00 <br /> TOTAL $187.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> GILLS SMOG CHECK 209-346-4318 <br /> EMPLOYER STREET CITY ST ZIPCODE <br /> 2171 E CHEROKEE RD STOCKTON CA 95205 <br /> SPQVri& CO—OWNER <br /> ST FIRST MI TITLE SOC SEC NO I DOB I DR LIC NO I AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> GILLS SMOG CHECK 209-346-4318 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2171 E CHEROKEE RDOC T N CA 95205 <br /> REPARED BY CHECKED BY DATE �/� Coy. zo (areal <br />