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CPG # T0: DICE OF REVENUE AND RECOVERY COPY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT.NO. DATE REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> CORROBILT CONTAINER COMPANY <br /> C/O NAME GUARANTOR SSN <br /> RALPH LEYVA,TOM LUCIA, PAUL BELLEAU <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1217 MOFFAT BLVD MANTECA CA 95336 209-249-3100 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 209-249-3100 <br /> USER REFERENCE NO. BILLI CYCLEI STATUS DATEI BM CBMC INT MONTHLY PAY AMT <br /> 10441 HAZMAT I I I I I I I I I I I 1 11 , 1 113/151071 <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 /> NO <br /> 230 026000.0 2007 Hmmp Annual Fee $240.00 <br /> 4 Chems @ $15.00 Each $60.00 <br /> 10% Late Charge $30.00 <br /> State Service Fee $24.00 <br /> TOTAL $354.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CORROBILT CONTAINER COMPANY 209-249-3100 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1217 MOFFAT BLVD MANTECA CA 95336 <br /> 9F9UM CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CORROBILT CONTAINER COMPANY 209-249-3100 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1217 MOFFAT BLVD MANTECA CA 95336 <br /> PREPARED BY CHECKED 8 DATE 7 COL. zo iaree <br />