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CPG # TO: OFFICE OFC REVENUE AND RECOVERY c�' OPoyACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 1.14 <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> BROWER DURABLE TRANSMISSIONS, <br /> C/O NAME GUARANTOR SSN <br /> C RAY BROWER <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1204 ENTERPRISE ST STOCKTON CA 95204 209-610-6075 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3118 ESTATE DRIVE STOCKTON CA 95209 209-610-6075 <br /> USER REFERENCE NO. BILL TAT CYCLE I STATUS DATE BMd CBMINT MONTHLY PAY AM3/20/10 <br /> T <br /> ATP <br /> PYMT PR <br /> 732 HAZMAT <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NOINARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGEDEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> Kin230 026000.0 Sm Hw Gen <5 Tons/yr $213.00 <br /> 2010 Hazmat Fee $115.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge Fee $25.00 <br /> Hazmat Penalty Fee $11.50 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $601.50 <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 /> BROWER DURABLE TRANSMISSIONS, INC 209-610-6075 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1204 ENTERPRISE ST STOCKTON CA 95204 <br /> SPQUfS& CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I -I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> BROWER DURABLE TRANSMISSIONS, INC 209-610-6075 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1204 ENTERPRISE ST S,T P N CA 95204 <br /> PREPARED BY CHECKED BY DATE ,a S_y 0 COL. zo t M)e <br />