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CPG'# TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL ../ C O py <br /> ACCOUNT NO. DEPT. NO. 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 SSN <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. IBILL kTAT ICYCLE STATUS DATE BM CBM INTI MONTHLY PAY AMT PYMT I PROB <br /> 14144 HAZMAT 1.3/20/1.0 <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 /> CHARGEKin DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 Sm Hw Gen<5 Tons/yr $213.00 <br /> 2010 Hazmat Fee $100.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge Fee 1 $25.00 <br /> Hazmat Penalty Fee $10.00 <br /> Permit Fee Penalty $213.00 <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 /> SPARS€ CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I 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 LVD TOCKTON CA 95204 <br /> CHECKED BY ATE coyzo lselREPARED BY <br />