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CPG'# TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO. REFERRAL ((t(v\J\J V <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> CUSTOM METAL FINISHING <br /> C/O NAME GUARANTOR SSN <br /> NEIL DAVIS&TERRI TAYLOR <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1550 SHAW RD #CSTOCKTON CA 95215 209-505-0037 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 4212 ELDENBERRY CT MODESTO CA 95356 209-918-0815 <br /> USER REFERENCE NO. IBILL kTAT ICYCLE ISTATUS DATEI BM CBM INT MONTHLY PAY AMT I PYMT PR <br /> TF <br /> 9554 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 CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> Nlr)230 026000.0 Sm Hw Gen<5 Tons/yr $213.00 r.. <br /> 2010 Hazmat Fee $360.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge Fee $25.00 <br /> Haz Mat Penalty Fee $36.00 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $871.00 <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 /> CUSTOM METAL FINISHING 209-505-0037 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1550 SHAW RD#C STOCKTON CA 95215 <br /> S;OU" CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. I DOB DR LIC NO AUTO LIC NO <br /> I I i <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CUSTOM METAL FINISHING 209-505-0037 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1550 SHAW RD; TOC - CA 95215 <br /> PREPARED BY , CHECKED BY 5--144 COL M(3/HB) <br />