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CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> DATE <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> RODEL CLEANING SPECIALISTS <br /> C/O NAME GUARANTOR SSN <br /> RODEL CLEANING SPECIALISTS <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> RODEL CLEANING SPECIALISTS 90 S SPRUCE AVE SAN FRANCISCO CA 94080 209-466-1111 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 90 SO.SPRUCE AVE.-SUITE 0 SO. SAN CA 94080 650-952-8422 <br /> USER REFERENCE NO. I BILL STA CYCLE STATUS DATE BM CBMC INT I MONTHLY PAY AMTF:DATE TERM DATE <br /> 11113 HAZMAT 316104 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> nog <br /> SERVICE DATE: DATE OF <br /> E230 <br /> STOP MED REC NO CHARGE <br /> DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> 026000.0 1999-2004 Hmmp <br /> Annaul Fee $420.00 <br /> 1999-2004 1 Chem @ <br /> $15.00 Each Year $90.00 <br /> 10% Late Charge $51.00 <br /> State Service Fee $24.00 <br /> :::4TOTAL $585.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY STZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> RODEL CLEANING SPECIALISTS 209-466-1111 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 612 LUCE ST ROUGH&READY ISLAND STOCKTON CA 95203 <br /> S£9TBH CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO I AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> RODEL CLEANING SPECIALISTS 209-466-1111 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 612 LUCE ST ROUGH&READY ISLAND STOCKTON CA 1 95203 <br /> PREPARED BY I CHECKED BY JDATE COL. 21 1118 <br />