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CPh # TO: 41F ICE OF REVENUE AND RECOVERY Is ACCOUNT TRANSMITTAL D ACCOUNT NO. DEPT. NO. I REFERRAL O / llll 026000.0 LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE STOCKTON TRANSPORT C/O NAME GUARANTOR SSN RICHARD WELSH MAILING STREET CITY ST ZIP CODE AREA PHONE NO. 4408 S HWY 99 STOCKTON CA 95215 209-946-0648 RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. 209-946-0648 USER REFERENCE NO. I BILL SjAj CYCLE STATUS DATE BMC CBMC INT MONTHLY PAY AMT _nATF TERM DATE 4954 HAZMAT 3/15/08 CHARGES LAST - RECIPIENT - FIRST MI TITLE RECInR PIENT USER REFERENCE NO/NARRATIVE SERVICE DATE:DATE MED RED NO OF CHARGE START STOP DEPT. NO. DESCRIPTION AMOUNT NO. NO DESCRIPTION AMOUNT L23 026000.0 2008 Hmmp Annual Fee $240.00a 2 Chems @ $15.00 Each $30.00 10% Late Fee 0DEP1. $27.00 State Service Fee $24.00 Used Oil Only -<5 Tons/yr $54.0011 11/IS Permit Fee Penalty $54.00 77 T,, - Z, 1 1+1 1 1 1 �Xk TOTAL $429.00 GUARANTOR DOB DR LIC NO AUTO LIC NO PRIOR STREET CITY ST ZIP CODE EMPLOYER NAME EMPLOYER PHONE NO STOCKTON TRANSPORT REFRIGERATION 209-946-0648 EMPLOYER STREET CITY ST ZIP CODE 4408S HWY 99 STOCKTON CA 95215 CO-OWNER LAST FIRSTMI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO WELSH RENEE EMPLOYER NAME EMPLOYER PHONE NO STOCKTON TRANSPORT REFRIGERATION 209-946-0648 EMPLOYER STREET CITY ST ZIP CODE 4408 S HWY 99STOCKTON CA 95215 PREPARED BY , // / CHECKED BY DATE / . ,1 -en, nn �eraa