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CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL COPY <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> nATr <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> BAMBU'S TRANSMISSIONS (CLOSED) <br /> C/O NAME GUARANTOR SSN <br /> CATARINO OCAMPO <br /> MAILING STREET CITY EST ZIP CODE AREA PHONENO. <br /> 1100 E MAIN ST STOCKTON CA 95205 209-464-3611 <br /> RESIDENCE STREET CITY ZIP CODE AREA PHONE NO. <br /> 3267 S ELDORADO ST STOCKTON CA 95206 209-463-4547 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT PYM PR B <br /> 8306 HAZMAT 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 DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 Sm Hw Gen <5 Tons/yr $213.00 <br /> 2010 Hazmat Fee $85.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge Fee $25.00 <br /> Hazmat Penalty Fee $8.50 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $568.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> BAMBU'S TRANSMISSIONS (CLOSED) 209-464-3611 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1100 E MAIN ST STOCKTON CA 95205 <br /> S-F6i�TSE� CO—OWNER <br /> ST FIRST MI TITLE SOC SEC NO, DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> BAMBU'S TRANSMISSIONS (CLOSED) 209-464-3611 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1100E MAIN ST STOCKTON _. OA 95205 <br /> REPARED BY CHECKED BY DATE Z �b GOL p (3re8) <br />