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CPG/# TO: FICE OF REVENUE AND RECOVERY J�//'' �PD• ACCOUNT TRANSMITTALU ACCOUNTNO. DEPT.NO. REFERRALnATP <br /> � <br /> 026000.0 8/8/03 <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. I BILL HAA CYCLE STATUS DATEI BM CBMCI INT MONTHLY PAY AMT <br /> 6940 HAZMAT 6/15/03 <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 /> NONO <br /> 230 026000.0 2003 Hmmp Annual Fee $240.00 <br /> 5 Chems @ $15.00 Each $75.00 <br /> 10% Late Charge $31.50 Aesi <br /> Ilk <br /> TOTAL $346.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> MOKELUMNE RIVER FISH HATCHERY 209-759.3383 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 25800 N MCINTIRE RD CLEMENTS CA 95227 <br /> SP98933 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 ZIPCODE <br /> 25800 N MCINTIRE RD CLEMENTS CA 95227 <br /> PREPARED BY - ,y „ CHECKED ATE 8&03 coL. 20 1&88 <br />