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CPG # TO: 7ICE OF REVENUE AND RECOVERY <br /> "-' ACCOUNT TRANSMITTAL COPY ACCOUNT NO. DEPT.NOREFER. RAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> COPPER ENTERPRISES INC <br /> C/O NAME GUARANTOR SSN <br /> DON LITCHFIELD <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 12470 E LOCKE RD BLDG 100LOCKEFORD CA 95237 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. I BILLI STAI CYCLE1 STATUS DATEI BM C13MCI INT MONTHLY PAY AMT <br /> 9158 HAZMAT FIT I I I t I I I-f3/15/08 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP I MED REC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> NO <br /> 230 026000.0 2008 Hmmp Annual Fee $240.00 <br /> 4 Chems @ $15.00 Each $60.00 <br /> 10% Late Charge $30.00 AL IS UP <br /> State Surcharge Fee $24.00 AFry <br /> Sm Hw Gen <5tons/yr $213.00 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $780.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> COPPER ENTERPRISES INC 209-727-9770 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 12470 E LOCKE RD BLDG 100 LOCKEFORD CA 95237 <br /> OFeff" CO—OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> COPPER ENTERPRISES INC 209-727-9770 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 12470 E LOCKE RD BLDG 100 LOCKEFORD CA 95237 <br /> PREPARED BY - CHECKED BY tp - �xcBATE `7 O� COL. 20 ranee <br />