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CPG # T0: (1FFICE OF REVENUE AND RECOVERY Copy ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. =DEPT-N REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> ABOVE ALL AUTO REPAIR <br /> C/O NAME GUARANTOR SIN <br /> RICHARD COSTELLO <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2151 COUNTRY CLUB BLVD STOCKTON CA 95204 209-466-2715 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 209-466-2715 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT PFM PR <br /> OB <br /> 14144 HAZMAT 11 11 1 4/15/11 <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 /> 230 042000.0 2011 Hazmat Fee $100.00 380 042000.0 <br /> 230 042000.0 Haz Mat Penalty Fee $10.00 380 042000.0 <br /> 380 042000.0 Sm Hw Gen <5 Tons/yr $213.00 380 042000.0 <br /> 380 042000.0 Permit Fee Penalty $213.00 380 042000.0 <br /> 380 042000.0 State Surcharge Fee $24.00 380 042000.0 <br /> 380 042000.0 Electronic Surcharge Fee $25.00 380 042000.0 <br /> 380 042000.0 380 042000.0 <br /> TOTAL $585.00 <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 /> ABOVE ALL AUTO REPAIR 209-466-2715 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2151 COUNTRY CLUB BLVD STOCKTON CA 95204 <br /> CO-OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO I AUTO LIC NO <br /> I 1 <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ABOVE ALL AUTO REPAIR 209-466-2715 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2151 COUNTRY C UB B V TOCKTON CA 95204 <br /> PREPAREDEI CHECKED BY DATE 7� COL. zo (areal <br />