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CifG # TO: ^FFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL ./ COPY ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> CV FABRICATORS INC <br /> C/O NAME GUARANTOR SSN <br /> CV FABRICATORS INC <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 17547 COMCONEX RD MANTECA CA 95336 209-239-7500 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 209-239-7500 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT PY T PR B <br /> 13353 HAZMAT 1. <br /> 3/20/11 <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 2011 Hazmat Fee $345.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $34.50 <br /> TOTAL $428.50 <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 /> CV FABRICATORS INC 209-239-7500 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 17547 COMCONEX RD MANTECA CA 95336 <br /> S-POUSB 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 <br /> CV FABRICATORS INC 209-239-7500 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 17547 COMCONEX RD MAN; CA CA 95336 <br /> REPARED BY CHECKED B DATE �// coL. W (area) <br />