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CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> j 642000 01 ZLZS),q'? <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> ELON INC(CLOSED) I I I I I i I j I 1 1 7�7 <br /> C/O NAME GUARANTOR SSN <br /> RICHARD EVANS I I I I I I Robert Evans, Manager <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 17333 S COMCON EX RD MANTECA CA 95336 209-481-5180 <br /> RESIDENCE STREET CITY ST ZIPCODE AREA PHONENO. <br /> 891 MONTICELLO LANE MANTECA CA 95336 209-481-5180 <br /> USER REFERENCE NO, BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT I nip IFT <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 Tax ID$68-0246286 <br /> 0 9 P91 91 ,29, 0 <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT HARGE DEPT.NO. DESCRIPTION AMOUNT <br /> Nn <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 230 026000 6 Chems @ $15.00 Each $90.00 <br /> 30 2 000 10% Late Charge $33.00 <br /> 80 4 00 State Surcharge Fee $24.00 <br /> 1 1 <br /> 80 9400.0 Sm Hw Gen<5tons/yr $213.00 <br /> 80 94OOPPermit Fee Penalty $213.00 <br /> Invoice IF 184707 <br /> TOTAL $813.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIPCODE <br /> 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 95336 <br /> S-POU" CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO "�y/IkW <br /> ELON INC(CLOSED) 209-481-5180 <br /> EMPLOYER STREET STREET CITY ST ZIP CODE <br /> 17333 S COMCONEX RD MANTECA CA 95336 <br /> REPARED BY 9 1 CHECKED gy DATE 30 0� COL. zo la�ael <br /> i <br />