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CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL �./ C <br /> O py <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> COPPER ENTERPRISES INC (CLOSED) <br /> C/O NAME GUARANTOR SSN <br /> DON LITCHFIELD <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> COPPER ENTERPRISES INC (CLOSED) P.O. BOX 70 FAIR OAKS CA 95629-0070 209-727-9770 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 12470 LOCKE ROAD, BLDG. 100 LOCKEFORD CA 95237 209-727-9770 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT I PYMT PR <br /> 9158 HAZMAT 1. <br /> 3/20/10 <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 HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 Sm Hw Gen<5 Tons/yr $213.00 <br /> 2010 Hazmat Fee $300.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge Fee $25.00 <br /> Haz Mat Penalty Fee $30.00 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $805.00 <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 /> COPPER ENTERPRISES INC (CLOSED) 209-727-9770 <br /> EMPLOYER STREET F CITY ST ZIP CODE <br /> 12470 E LOCKE RD BLDG 100 LOCKEFORD CA 95237 <br /> SPOUSE- CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> 1 I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> COPPER ENTERPRISES INC (CLOSED) 209-727-9770 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 12470 E LOCKE RD BLDG.1p(hCKEFORD CA 95237 <br /> PREPAREDBY - CHECKED BY iG DATE -� 5-� L.O COL. 20 ( W, <br />