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CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> Ah ACCOUNT TRANSMITTAL ACCOUNT NO. DEPT. NU. !0F1yREFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> B.V.O.S. INC <br /> C/O NAME GUARANTOR SSN <br /> ROBERT JIMENEZ <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> B.V.O.S. INC P.O. BOX 30366 STOCKTON CA 95213 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BMI CBMI INT MONTHLY PAY AMT PYMT I PROS <br /> 14232 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 Kin DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2009 & 2010 Hazmat Fee $570.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $57.00 <br /> TOTAL $676.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> B.V.O.S. INC <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1580 REPORT AVE STE 1 STOCKTON CA 95213 <br /> S-F94JSF� CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> B.V.O.S. INC <br /> EMPLOYER STREET CITY ST ZIPCODE <br /> 1580 REPORT AVE STE 1 S CK ON CA 95213 <br /> PREPARED B CHECKED BY DATE t�7.. �,O coy 20 (01813) <br />