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CPG # TO: ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL cc F)v <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> QATF <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> STORER TRANSPORTATION <br /> CIO NAME GUARANTOR SSN <br /> DONALD STORER <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> STORER TRANSPORTATION 3519 MCDONALD AVE MODESTO CA 95358 209-758-7911 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3519 MCDONALD AVE. MODESTO CA 95358 209-644-5114 <br /> USER REFERENCE NO. I BILL I STA CYCLE STATUS DATEI BMA CBMCJ INT I MONTHLY PAY AMT <br /> I; RM QATE <br /> 12286 HAZMAT 2123105 <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 /> NO <br /> 230 026000.0 2002 - 2004 Hmmp <br /> Annual Fee $720.00 <br /> 4 Chems @ $15.00 <br /> Each Year $180.00 IL <br /> 10% Late Charge $90.00 <br /> TOTAL $990.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST 7JP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> STORER TRANSPORTATION 209-758-7911 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2447 STAGECOACH RD STOCKTON CA 95215 <br /> &#a u" CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> STORER TRANSPORTATION 209-758-7911 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2447 STAGECOACH RD STOCKTON CA 95215 <br /> PREPARED BY CHECKED BY DATE Z u SI coy. Po (m8 <br />