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CPG # TO: ICE OF REVENUE AND RECOVERY • <br /> ACCOUNT TRANSMITTAL COID 11 <br /> ACCOUNTNO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> ROLLING FRITO LAY SALES <br /> C/O NAME GUARANTOR SSN <br /> FRITO LAY INC <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> ROLLING FRITO LAY SALES 4029 LECKRON RD MODESTO CA 95357 209-544-5427 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 7701 LEGACY DR PLANO TX 75024 972-334-7000 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BMd CBMd INT MONTHLY PAY AMT PYMT R B <br /> 9579 HAZMAT 1.3/15/09 <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 DR&N SCRIPTION AMOUNT <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 6 Chems Q $15.00 Each $90.00 <br /> 10% Late Charge $33.00 <br /> State Service Fee $24.00 <br /> Sm Hw Gen<5 Tons/yr $213.00 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $813.00 <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 /> ROLLING FRITO LAY SALES 209-544-5427 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1190 SPRECKELS RD MANTECA CA 95336 <br /> &POW-&& CO-OWNER <br /> ST FIRST MI TITLE SOC SEC NO. I DOB DR LIC NO I AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ROLLING FRITO LAY SALES 209-544-5427 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1190 SPRECKELS RD MANTECA CA 95336 <br /> REPARED BY CHECKED BY /x�/ ATE / c� OOL. M(3M) <br />