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..PG, TO: )FFICE OF REVENUE AND RECOVERY ../ <br /> ACCOUNT TRANSMITTAL COPYACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE <br /> LAST - AKA - FIRST MI TITLE <br /> PAUL'S AUTO REPAIR <br /> C/O NAME GUARANTOR SSN <br /> PAUL W WONG <br /> MAILING STREET CITY <br /> ST ZIP CODE AREA PHONE NO, <br /> 1146 ENTERPRISE ST STOCKTON CA 95204 <br /> 209-462-6828 <br /> RESIDENCE STREET CITY <br /> ST ZIP CODE AREA PHONE NO. <br /> 209-462-6828 <br /> USER REFERENCE NO. BILL STA CYCLE STATUS DATE BM CBMC INT MONTHLY PAY AMT <br /> 11966 HAZMAT <br /> 3/15/08 <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. CHARGE <br /> NO DESCRIPTION AMOUNT DEPT�NY7".F; DESCRI TION AMOUNT <br /> 230 026000.0 2008 Hmmp Annual Fee $70.00 <br /> 2 Chems G $15.00 Each $30.00 \ <br /> 10% Late Charge $10.00 <br /> State Surcharge Fee $24.00 <br /> t <br /> TOTAL $134.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONEN 0 <br /> PAUL'S AUTO REPAIR 209-462-6828 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1146 ENTERPRISE ST STOCKTON tCA 95204 <br /> __ CO—OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <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 /> PREPARED <br /> BY CHECKED B <br /> z11 X- DATE i ��/�� COL 20 (aae <br />