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CPG # TO: 'VICE OF REVENUE AND RECOVERY <br /> .,� ACCOUNT TRANSMITTAL .1 COPY <br /> ACCOUNT NO. DEPT. NO. REFERR <br /> 026000.0 AL <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> BA_RRO_S'AG WELDING AND TRAILER <br /> C/O NAME GUARANTOR SSN <br /> JJGS CORP <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> BARROS'AG WELDING AND TRAILER REPAIR 1623 THIRD ST ESCALON CA 95320 209-838-6425 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1623 THIRD STREET ESCALON CA 95320 209-838-6425 <br /> USER REFERENCE NO. BILL bTAT CYCLE STATUS DATE BM CBMd INT MONTHLY PAY AMT PYMT <br /> 11518HAZMAT 1 1 11 11 11 1 1 1 1 1 1 1 3/15/09 <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 /> DIG <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 2 Chems @ $15.00 Each $30.00 <br /> 10% Late Charge $27.00 <br /> State Surcharge Fee $24.00 <br /> :�::4TOTAL $321.00 <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 /> BARROS'AG WELDING AND TRAILER REPAIR 209-838-6425 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 26414 LONE TREE RD ESCALON CA 95320 <br /> SPQUSZ� CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> 1 I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> BARROS'AG WELDING AND TRAILER REPAIR 209-838-6425 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 26414 LONE TREE RD ESCALO CA 95320 <br /> REPARED 8 CHECKED B ATE 2,p Q� cpL p (ift) <br /> i Y <br />