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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 /> SILVESTRE'S CONST MECH CO <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 /> PR <br /> USER REFERENCE NO. BILL kTAT ICYCLE ISTATUS DATE BMd CBMI INT MONTHLY PAY AMT I MT <br /> 14045 HAZMAT 1.3/20/11 <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 CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 380 042000.0 2011 Hazmat Fee $360.00 <br /> 380 042000.0 State Surcharge Fee $24.00 <br /> 380 042000.0 Electronic Surcharge $25.00 <br /> 380 042000.0 Hazmat Penalty Fee $36.00 <br /> 380 042000.0 Cal Arp Surcharge Fee $270.00 <br /> 380 042000.0 <br /> 360 042000.0 <br /> TOTAL $715.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY 5T ZIP CODE <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 /> SiQU49 CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I 1 <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 DI CA 95240 <br /> PREPARED BY CHECKED BY ATE 14 _11_// COL. 20 (3IBBI <br /> 1( 0b <br />