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GPG # TO: *ICE OF REVENUE AND RECOVERY 40 <br /> ACCOUNT TRANSMITTAL COPY <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> NORTHWEST PALLETS <br /> CIO NAME GUARANTOR SSN <br /> RICARDO OCHEA AND MIGUEL OCHOA <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1044 NAVY DR STOCKTON CA 95206 209-462-6011 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1044 NAVY DR STOCKTON CA 209-462-6011 209-462-6011 <br /> USER REFERENCE NO. BILL STAA CYCLE STATUS DATE BM CBMC INT MONTHLY PAY AMT <br /> TERM <br /> 10896 HAZMAT I -1FTi -1 I I I I 7/15107 <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 2003-2007 Hmmp <br /> Annual Fee $350.00 <br /> 1 Chem @ $15.00 <br /> Each Year $75.00 <br /> 10% Late Charge $42.50 <br /> State Surcharge Fee $24.00 <br /> TOTAL $491.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> NORTHWEST PALLETS 209-462-6011 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1044 NAVY DR STOCKTON CA 95206 <br /> .q.PE)B.O} CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> NORTHWEST PALLETS 209-462-6011 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1044 NAVY DR STOCKTON CA 95206 <br /> PREPARED BY CHECKED BY DATECOL. 20 (3188 <br /> �z�7 <br />