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CPG # T0: OFFICE OF REVENUE AND RECOVERY ACCOUNT TRANSMITTALCOPY <br /> ACCOUNMFIRST <br /> O. REFERRAL <br /> .0 <br /> LAST - GUARMI TITLE LAST - AKA =ZIPCODEAREA <br /> FIVE STAR AC/O NAMEGUARANTOR SSNALEX FLORE <br /> MAILING STREET CITY ST <br /> 2560 S EL DORADO ST STOCKTON CA 95206 209-817-7396 <br /> RESIDENCE STREET CITY ST ZIPCODE AREA PHONE NO. <br /> 2531 S. LINCOLN ST. STOCKTON CA 95206 209-817-7396 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT PR <br /> OB <br /> 14416 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 HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> Kin230 042000.0 2011 Hazmat Fee $85.00 380 042000.0 <br /> 230 042000.0 Haz Mat Penalty Fee $8.50 380 042000.0 <br /> 380 042000.0 380 042000.0 <br /> 380 042000.0 380 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 $142.50 <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 /> FIVE STAR AUTO DETAIL 209-817-7396 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2560 S ELDORADO ST STOCKTON CA 95206 <br /> CO—OWNER <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> FIVE STAR AUTO DETAIL 209-817-7396 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2560 S EL DORAD T T C T NCA 95206 <br /> PREPARED BY CHECKED BY DATE —7-; -7—/ / coL. xo Ivael <br />