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CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL PY <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> JUAREZ METALS I 1 11 11 <br /> C/O NAME GUARANTOR SSN <br /> DEBORAHJUAREZ <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> JUAREZ METALS 1218 MACDUFF AVE STOCKTON CA 95209 209-473-4368 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1218 MACDUFF AVE STOCKTON CA 95209 209-473-4368 <br /> PYMT <br /> USER REFERENCE NO. BILL FAT CYCLE STATUS DATE BMI CBM INT MONTHLY PAY AMT nI,FnATF <br /> TFpmnB <br /> 13243 HAZMAT 1.3/20/1.0 <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 HARGE DEPT.NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2010 Hazmat Fee $270.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $27.00 <br /> TOTAL $346.00 <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 /> JUAREZ METALS 209-473-4368 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1411 E JACKSON ST STOCKTON CA 95205 <br /> SPOUSE- CO—OWNER <br /> I.AST FIRST MI TITLE SOC SEC NO. I DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> JUAREZ METALS 209-473-4368 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1411 E JACKSON ST ST KT CA 95205 <br /> REPARED BY CHECKED BY DATE a3 10 COL. 20 (3IB8) <br />