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CPG+.# TO: 0 ^ICE OF REVENUE AND RECOVERY . <br /> — ACCOUNT TRANSMITTAL0 CP <br /> �/)ACCOUNTNO. DEPT.NO. OV <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> J&B AUTO BODY <br /> C/O NAME GUARANTOR SSN <br /> JOHN FULLER <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> J&B AUTO BODY 2200 W COUNTRY CLUB BLVD STOCKTON CA 95204 (209)465-2281 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2200 COUNTRY CLUB BLVD. STOCKTON CA 95204 209-465-2281 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATEI BM CBM IN MONTHLY PAY AMT <br /> 2013 HAZMAT 3/1 5/1 2 <br /> LAST - RECIPIENTS- FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> 4w ABU <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION <br /> 230 042000.0 2012 Hazmat Fee $270.00 p8q <br /> 30 0142 90010 Hazmat Penalty Fee $27.00 p8qa 00 .0 n <br /> 8q42900,0 State Surcharge Fee $24.00 p8q <br /> �Bq I 0 2 00 0 I Electronic Surcharge Fee $25.00 8q 1 P43009-01 <br /> 80 0 2 <br /> 90010 1 p8q <br /> 80 1 014290010 8 4 00 .0 <br /> 80 1 0l42q00.PB 4 00 .0 <br /> TOTAL $346.00 <br /> GUARANTOR <br /> PRIOR STREET r.1TY sT ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> J&S AUTO BODY (209)465-2281 <br /> EMPLOYERSTREET CITY ST ZIP CODE <br /> 2200 COUNTRY CLUB BLVD STOCKTON CA 95204 <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 /> J&B AUTO BODY (209)465-2281 <br /> EMPLOYER STREET RT 71P QQDF <br /> 2200 COUNTRY CLUB BLVD OCKTON CA 95204 <br /> CHECKED BY IDATE COL. 2n PIRP, <br />