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CPG # TO: G CE OF REVENUE AND RECOVERY • /f vJ/ \\II�I`\� ACCOUNT TRANSMITTAL 1t Il J'I� lv/ ACCOUNT NO. DEPT. NO. REFERRAL 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 BILLI STA CYCLEI STATUS DATEI BM CBMCI INT I MONTHLY PAY AMT UF QATF TERM DATE 4954 SAT 1/24/05 CHARGES LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATNE SERVICE DATE: MED REC NO DATE OF CHARGE START STOP CHARGE NO DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT 230 026000.0 2005 Hmmp Annual Fee $240.00 2 Chems @ $15.00 Each $30.00 10% Late Fee $27.00 State Service Fee $24.00 r Sm Hz Gen <5 Tons/yr $50.00 ley Permit Fee Penalty $50.00 TOTAL $421.00 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 4408 S HWY 99 STOCKTON CA 95215 SE4)USr' CO-OWNER LAST FIRST MI 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 ZIPCODE 4408 S HWY 99 STOCKTON CA 95215 REPARED BY.�c.// CHECKED BY DATE I COL 20 �p= /� 4'/o s—