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CPG'# TO: OFFICE REVENUE AND RECOVERY py <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> (0 (0 <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> BERNICK MECHANICAL <br /> C/O NAME GUARANTOR SSN <br /> RICK ABRAHAMSON <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> BERNICK MECHANICAL 1040W KETTLEMAN LN LODI CA 95240 209-334-1960 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1743 LAKESHORE DRIVE LODI CA 95242 209-334-1960 <br /> USER REFERENCE NO. BILL kATICYCLEISTATUS DATE BMd CBMd INT MONTHLY PAY AMT 1711 11,nATP <br /> TPPRAnATP <br /> B <br /> 13474 HAZMAT 3/20/10 <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 HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> Kin230 026000.0 2010 Hazmat Fee $255.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $25.50 <br /> TOTAL $329.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> BERNICK MECHANICAL 209-334-1960 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1621 NAVY DR BLDG#6 STOCKTON CA 95206 <br /> SAABS& CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO I AUTO LIC NO <br /> I 1 I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> BERNICK MECHANICAL 209-334-1960 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1621 NAVY DR BLDG#6 STOC TON CA 95206 <br /> REPARED BY CHECKED BYDATE L/oV +��/C COL. 20(3138) <br />