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CPG # ' TO: OFFICE OF REVENUE AND RECOVERY 1 (0py <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE7 LAST - AKA - FIRST MI TITLE <br /> AQUA POOL& SPA <br /> C/O NAME GUARANTOR SSN <br /> RICHARD TOWNSEND <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> AQUA POOL& SPA P.O. BOX 598 RIPON CA 95366-0598 209-652-1196 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 21238 S. MURPHY RD. RIPON CA 95366 209-249-6800 <br /> PYMT PROB <br /> USER REFERENCE NO. BILL TTATCYCLEST=1E3V1-jFCBMdINT MONTHLY PAY AMT <br /> 12061 HAZMAT 3/20/11 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> nQu <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2011 Hazmat Fee $345.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $34.50 <br /> TOTAL $428.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> AQUA POOL& SPA 209-652-1196 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1869 E MOFFAT BLVD MANTECA CA 95336 <br /> 94*U-S& 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 /> AQUA POOL& SPA 209-652-1196 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1869 E MOFFAT BLVD MALATE A CA 95336 <br /> PREPARED BY <br /> C CHECKED BY COL. 20(3IBB) <br />