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f CPG'# - TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO. REFERRAL -" C (OR 026000.0 <br /> LAST - GUARANTOR FIRST M1 TITLE LAST AKA FIRST MI TITLE <br /> PACIFIC MUFFLER <br /> C/O NAME GUARANTOR SSN <br /> J&J JOHNSON INVESTMENTS LLC <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> PACIFIC MUFFLER 133 W HARPING WAY STOCKTON CA 95204 209-986-8025 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 4225 HAWK CT STOCKTON CA 95209 (209)952-7600 <br /> USER REFERENCE NO, BILL TAT"CYCLE STATUS DATE BM CSM IN MONTHLY PAY AMT PYMT PRO9- <br /> 5725 HAZMAT 3/20110 <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 /> CHARGEDEPT. NO. DESCRIPTION AMOUNT HARGE DEPT.NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2010 Hazmat Fee $285.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00" <br /> Hazm'at Penalty Fee $28.50 <br /> TOTAL $302.50 <br /> GUARANTOR <br /> DOS DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> PACIFIC MUFFLER 209-986-8025 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 133 W HARPING WAY STOCKTON CA 95204 <br /> S-P�Ai3S9 CO-OWNER .:_ <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> PACIFIC MUFFLER 209-986-8025 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 133 W HARDING WAY STO KT CA 95204" <br /> PREPARED BY CHECKED BY ATE //a COL 20 (3M) <br /> a <br />