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CPG # TO: 'TICE OF REVENUE AND RECOVERY <br /> N,. ACCOUNT TRANSMITTAL y O <br /> ^� <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> PAUL'S AUTO REPAIR E� 11 111 111111 . 1 . 1 <br /> C/O NAME GUARANTOR SSN <br /> PAUL W WONG <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1146 ENTERPRISE ST STOCKTON CA 95204 209-462-6828 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 209-462-6828 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BMd CBMd INT MONTHLY PAY AMT I P M PR <br /> 11966 HAZMAT 1.3/1 <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. ESCRIPTION AMOUNT <br /> 230 026000.0 2009 Hmmp Annual Fee $70.00 <br /> 2 Chems @ $15.00 Each $30.00 <br /> 10% Late Charge $10.00 <br /> State Surcharge Fee $24.00 <br /> TOTAL $134.00 <br /> GUARANTOR <br /> DOB DR LIG NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> PAUL'S AUTO REPAIR 209-462-6828 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1146 ENTERPRISE ST STOCKTON CA 95204 <br /> SPOU99 CO—OWNER <br /> ST FIRST MI TITLE SOC SEC NO. I DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> PAUL'S AUTO REPAIR 209-462-6828 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1146 ENTERPRISE ST STOCKTON CA 9 04 <br /> PREPARED BY f 9 CHECKED BY DATE /Z� �� COL. 20 (3/88) <br />