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TO: OFFICE OF REVENUE & RECOVERY <br /> CPG: ACCOUNT TRANSMITTAL <br /> ACCOUNT NO DEPT NO REFERRAL DATE <br /> 1-Z1-733'9' 0420000 /I zl II <br /> LAST- -GUARANTOR. FIRST MI LASt ARA FIRST MI 7 <br /> Evans Robert <br /> C/O NAME SSN/FED# DR.LIC.NO. <br /> Elon Inc 68.0246286 <br /> MAILING STREET CITY ST ZIP AREA PHONE# <br /> 891 Monticello Ln Manteca CA 95336 <br /> FACILITY ADDRESS CITY ST ZIP <br /> 17333 S Comconex Rd Manteca CA 95336= <br /> USER REFERENCE NO <br /> Inv#211380 <br /> COMMENTS: <br /> SERVICE DATE: <br /> START STOP <br /> 1/28/2011 1/28[2011 <br /> cxNonDEPT NO DESCRIPTION AMOUNT cxNO a DEPT NO DESCRIPTION AMOUNT <br /> Inv#211380 <br /> 380 0420000 SM HW Gen Permit 213.00 <br /> 380 0420000 AST Facility Permit 675.00 <br /> 380 0420000 State Surcharge Fee 24.00 <br /> 380 0420000 Electronic Reporting 25.00 <br /> 380 0420000 Permit Fee Penalty 213.00 <br /> 380 0420000 Permit Fee Penalty 675.00 <br /> TOTAL 1,825.00 <br /> EMPLOYER NAME/SOURCE OF INCOME: EMPLOYER PHONE# <br /> EMPLOYER STREET CITY ST ZIP <br /> PREPARED BY: DATE: S'REVIEWED BY, DATE: /; <br />