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CPG # TO: ICE OF REVENUE AND RECOVERY • <br /> ACCOUNT TRANSMITTAL c <br /> 0 �rj-���/fACCOUNT NO. DEPT.NO. REFERRAL o 11 \LI"JI/ <br /> 026000.0 Ll <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> SEI-SLABY ENVIRONMENTAL INC <br /> C/O NAME GUARANTOR SSN <br /> DEBBIE&ROBERT SLABY <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> SEI-SLABY ENVIRONMENTAL INC P.O. BOX 903 BORREGO SPRINGS CA 92004 760-767-0776 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 587 PALM CANYON DR BORREGO CA 92004 760-767-0776 <br /> -77 PHO13 <br /> DATE TERM DATE <br /> USER REFERENCE NO. I BILL STA CYCLE STATUS DATE BM CBMC INT MONTHLY PAY AMT <br /> 13317 HAZMAT 3/15/08 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> DOR <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 Hmmp 10% Late Charge $28.50 <br /> X <br /> Z <br /> TOTAL $28.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY STZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> SEI-SLABY ENVIRONMENTAL INC 760-767-0776 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 783 E ROTH RD FRENCH CAMP CA 95231 <br /> 9P9H9E CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NOAUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> SEI-SLABY ENVIRONMENTAL INC 760-767-0776 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 783 E ROTH RD FRENCH CAMP CA 95231 <br /> PREPARED B L CHECKED B DATE/ �� COL. 20 (W88 <br />