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CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL COPY ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> CALIFORNIA GAS STATION LLC <br /> C/O NAME GUARANTOR SSN <br /> FOSHAN MINHAS <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> CALIFORNIA GAS STATION LLC 2420 W GRANT LINE RD TRACY CA 95376 408-239-9624 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1484 GABLE CT TRACY CA 95376 209-832-8273 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BMd CBMd INT MONTHLY PAY AMT I PYMT I PROB <br /> 12452 HAZMAT 3/20/10 <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 CHARGEKin DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 Sm Hw Gen <5 Tons/yr $213.00 Haz enalty Fee $10.00 <br /> 2010 Hazmat Fee $100.00 dkimPenalt 013.00 <br /> Ust State Surcharge Fee $45.00 <br /> Additional Ust $250.00 f <br /> Ust Facility Tank $550.00 <br /> Zn I <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge Fee $25.00 <br /> TOT $2230.00 <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 /> CALIFORNIA GAS STATION LLC 408-239-9624 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1399E YOSEMITE AVE MANTECA CA 95336 <br /> SSP} CO—OWNER <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CALIFORNIA GAS STATION LLC 408-239-9624 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1399 E YOSEMITE AV NT A CA 95336 <br /> REPARED BY - 1 CHECKED BY DATE COL. 20Feel <br />