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„CPG # TO: &ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL Copy ACCOUNT NO. DEPT.NO. nATREFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> LODI HIGH SCHOOL <br /> C/O NAME GUARANTOR SSN <br /> LODI UNIFIED SCHOOL DIST <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> LODI HIGH SCHOOL 1305 E VINE ST LODI CA 95240 209-331-7000 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1305 E VINE ST LODI CA 95240 209-331-7000 <br /> USER REFERENCE NO. BILL STA CYCLE STATUS DATE BM CBMC INT MONTHLY PAY AMT <br /> JF DAT TERM DATE <br /> 114 HAZMAT 3/15/07 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> DOB <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 2007 Hmmp Annual Fee $240.00 <br /> 3 Chems @ $15.00 Each $45.00 <br /> 10% Late Charge $28.50 <br /> State Service Fee $24.00 <br /> Sm Hz Gen <5 Tons/yr $206.00 <br /> Permit Fee Penalty $206.00 <br /> TOTAL $749.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> LODI HIGH SCHOOL 209-331-7000 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 3 S PACIFIC AVE LODI CA 95242 <br /> OPeUSE CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> LODI HIGH SCHOOL 209-331-7000 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 3S PACIFIC AVE LODI CA 95242 <br /> PREPARED e CHECKED BY DATE/ `�a�a 7 COL. 20 f,RR <br />