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CPG # TO: OFFICE OF REVENUE AND RECOVERY C O py <br /> ACCOUNT TRANSMITTAL �..1 <br /> ACCOUNT NO, DEPT. NO, <br /> REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE <br /> LAST - AKA - FIRST MI TITLE <br /> LUCERO TRUCKING <br /> GUARANTOR SSN <br /> C/O NAME <br /> RENELUCERO <br /> CITY ST ZIP CODE AREA PHONE NO. <br /> MAILING STREET <br /> LUCERO TRUCKING P.O. BOX 739 LINDEN CA 95236 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> Y R B <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE 8M CBM INT MONTHLY PAY AMT <br /> 3/20/10 <br /> 13516 HAZMAT <br /> CHARGES <br /> LAST -RRECIPIENTFIRSTMI TITLE RECIPIENT USER REFERENCE NOMARRATIVE <br /> SERDATE OF <br /> START MED REC NO CHARGE <br /> CHARGE DESCRIPTION AMOUNT HDEPT. NO. DESCRIPTION AMOUNT230 2010 Hazmat Fee $270.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $27.00 <br /> TOTAL 1 $346.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LICNO <br /> PRIOR STREET CITY STZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> LUCERO TRUCKING <br /> EMPLOYER STREET CITY ST ZIPCODE <br /> 4242 E MARIPOSA RD STOCKTON CA 95215 <br /> SFOWSR} CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> LUCERO TRUCKING <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 4242 E MARIPOSA RD STOCKY CA 95215 <br /> REPARED BY CHECKED BY ATE COL. zo (a�ael <br />