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CPG # TO: F'ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL .1 <br /> SELONINC(CLOSED) <br /> O. DEPT. NO. REFERRAL COPY <br /> 026000.0 <br /> OR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> GUARANTOR SSN <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 17333 S COMCONEX RD MANTECA CA 95336 209-481-5180 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 891 MONTICELLO LANE MANTECA CA 95336 209-481-5180 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BMd CBMd INT MONTHLY PAY A-MT1 P <br /> 12138 HAZMAT 1.3/15/09 <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 /> CHARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 6 Chems Q $15.00 Each $90.00 <br /> 10% Late Charge $33.00 <br /> State Surcharge Fee $24.00 <br /> Sm Hw Gen<5tons/yr $213.00 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $813.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ELON INC (CLOSED) 209-481-5180 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 17333 S COMCONEX RD MANTECA CA 95336 <br /> SPOUS& CO—OWNER <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ELON INC(CLOSED) 209-481-5180 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 17333 S COMCONEX RD MANTECA CA 1 95336 <br /> REPARED BY ICHECKED ATE ( Zo o O COL. 20 (3m) <br /> l/ <br />