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CPG*# TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL C <br /> 0 py <br /> ACCOUNT NO. DEPT. NO. �REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> SILVESTRE'S CONST MECH CO 1 11 11 11 11 11 <br /> C/O NAME GUARANTOR SSN <br /> SILVESTRE HERNANDEZ <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> SILVESTRE'S CONST MECH CO P.O. BOX 2507 LODI CA 95241 209-327-0749 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3713 MASSIMO CIRCLE STOCKTON CA 95212 209-327-0749 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT PFM PR <br /> 59— <br /> 14045 HAZMAT 1.3/20/110 <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 Kin DEPT_ NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2010 Hazmat Fee $360.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 - <br /> Hazmat Penalty Fee $36.00 <br /> TOTAL $445.00 <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 /> SILVESTRE'S CONST MECH CO 209-327-0749 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 6030 E KETTLEMAN LN LODI CA 95240 <br /> SPQU9& CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. I DOB DR LIC NO I AUTO LIC NO <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> SILVESTRE'S CONST MECH CO 209-327-0749 <br /> EMPLOYER STREET 1 CITY ST ZIP CODE <br /> 6030 E KETTLEMAN LN DI CA 95240 <br /> REPARED BY I CHECKED B ATE �/ 3 O coy. zo career <br />