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CPG # T0: 00E OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL O py <br /> ACCOUNTNO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> MOKELUMNE RIVER FISH HATCHERY <br /> C/O NAME GUARANTOR SSN <br /> EAST BAY MUNICIPAL UTILITIES DIST <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> MOKELUMNE RIVER FISH HATCHERY P.O. BOX 158 CLEMENTS CA 95227 209-759-3383 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> P.O. BOX 20445 OAKLAND CA 20445 510-287-0407 <br /> USER REFERENCE NO. PTTob <br /> I BILLI STAI CYCLEI STATUS DATEI BM CBMCI INT MONTHLY PAY AMT <br /> 6940 HAZMAT I I I I I I I I I I I I I j 4/15/06 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> DOR <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> NONO <br /> 230 026000.0 2006 Hmmp Annual Fee $240.00 <br /> 6 Chems @ $15.00 Each $90.00 <br /> 10% Late Charge $33.00 <br /> State Service Fee $24.00 <br /> Sm Hw Gen <5 Tons/yr $200.00 <br /> Permit Fee Penalty $200.00 <br /> TOTAL $787.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> MOKELUMNE RIVER FISH HATCHERY 209-759-3383 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 25800 N MCINTIRE RD CLEMENTS CA 95227 <br /> $F ffSH CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO, DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> MOKELUMNE RIVER FISH HATCHERY 209-759-3383 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 25800 N MCINTIRE RD CLEMENTS CA 95227 <br /> PREPARED BY CHECKED BY - DATE �7/U j COL. 20 f&88 <br />