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CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL ..f COPY ACCOUNTNO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> PAC-WEST ACQUISITION COMPANY LLC <br /> C/O NAME GUARANTOR SSN <br /> PAC-WEST ACQUISITION COMPANY LLC <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> PAC-WEST ACQUISITION COMPANY LLC 4210 CORONADO AVE STOCKTON CA 95204 209-926-3153 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 203 SE PARK PLAZA DR STE 270 VANCOUVER WA 98684 360-816-1840 <br /> USER REFERENCE NO. IE31LL TAT JCYCLF ISTATUS DATE BM CBMC INT MONTHLY PAY AMT I PYM PRO B <br /> 13592 HAZMAT 1.3/20/11 <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 HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 380 042000.0 2011 Hazmat Fee $270.00 <br /> 380 0142000.0 State Surcharge Fee $24.00 <br /> 380 Oa20oo.o Electronic Surcharge $25.00 <br /> 380 042000.0 Hazmat Penalty Fee $27.00 <br /> 380 042000.0 <br /> 380 042000.0 <br /> 380 042000.0 <br /> TOTAL $346.00 <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 /> PAC-WEST ACQUISITION COMPANY LLC 209-926-3153 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 4210 CORONADO AVE STE A STOCKTON CA 95204 <br /> SPOZIS& 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 /> PAC-WEST ACQUISITION COMPANY LLC 209-926-3153 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 4210 CORONADO AVE STE A S OCKTON CA 95204 <br /> REPARED BY CHECKED BV DATE �/�/� COL. 20 (3188) <br />