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CPG # TO: OFFICE REVENUE AND RECOVERY 0 �� <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> ALL TUNE& LUBE <br /> C/O NAME GUARANTOR SSN <br /> ALL TUNE & LUBE <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 543 W GRANT LINE RD #213TRACY CA 95376 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> USER REFERENCE NO. BILL TAT CYCLE STATCBM INT MONTHLY PAY AMT <br /> Y <br /> US DATE BMM B <br /> 14087 HAZMAT <br /> 3/20/10 <br /> CIII <br /> HARGES <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 /> 230 026000.0 2010 Hazmat Fee $115.o0 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $11.50 <br /> TOTAL $175.50 <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 /> ALL TUNE& LUBE <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 543 W GRANT LINE RD#213 TRACY CA 95376 <br /> SF Ugrb- 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 /> ALL TUNE& LUBE <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 543 W GRANT LINE RD#213 RACY CA 95376 <br /> REPARED BY CHECKED BY DATE /a3/�0 coL. zo Isree) <br />