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CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL N../ COPY <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> BRITE TRANSPORTATION INC <br /> C/O NAME GUARANTOR SSN <br /> SAM FREITAS <br /> MAILING STREET CITY ST ZIPCODE AREA PHONENO. <br /> 2420E EIGHT MILE RD STOCKTON CA 95210 209-474-0294 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 10118 RIVER FALLS CIRCLE STOCKTON CA 95209-4135 209-474-0294 <br /> USER REFERENCE NO. IBILL TAT ICYCLE ISTATUS DATEI BMd CBMCI INTI MONTHLY PAY AMT <br /> 14143 HAZMAT 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 CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 01, <br /> 230 042000.0 2011 Hazmat Fee $330.00 380 042000.0 <br /> 230 042000.0 Haz Mat Penalty Fee $33.00 380 042000.0 <br /> 380 042000.0 Gen 5<25 Tons Permit $1672.00 380 042000.0 <br /> 380 042000.0 Ast Fac 10k</=100k $675.00 380 042000.0 <br /> 380 042000.0 Permit Fee Penalties $2347.00 380 042000.0 <br /> Sao oa2000.0 State Surcharge Fee $24.00 380 oa20oo.0 <br /> 380 042000.0 Electronic Surcharge Fee $25.00 380 042000.0 <br /> TOTAL $5106.00 <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 /> BRITE TRANSPORTATION INC 209-474-0294 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2420E EIGHT MILE RD STOCKTON CA 95210 <br /> CO-OWNER <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> BRITE TRANSPORTATION INC 209-474-0294 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2420 E EIGHT MILE R STO TON CA 95210 <br /> PREPARED BY CHECKED BY PATE d �� COL. M (3m) <br /> r <br />