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CPG # TO: ICE OF REVENUE AND RECOVERY ACCOUNT TRANSMITTAL • ACCOUNT NO. DEPT. NO. REFERRAL ICOPY 026000.0 LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE HD SUPPLY WATERWORKS LTD C/O NAME GUARANTOR SSN HD SUPPLY WATERWORKS LTD MAILING STREET CITY ST ZIP CODE AREA PHONE NO. HD SUPPLY WATERWORKS LTD (WW7833) 1615 S STOCKTON ST LODI CA 92540 407-822.2822 RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. 501 W. CHURCH STREET ORLANDO FL 32805 407-822-2822 USER REFERENCE NO. IBILL TAT ICYCLE ISTATUS DATE I BMA CBMd I NTI MONTHLY PAY AMT I PYMT PR 13721 HAZMAT 12/15/08 CHARGES LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE SERVICE DATE: DATE OF START STOP MED REC NO CHARGE CHARGE mn DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT.N 0,,pA.4 CRIPTION AMOUNT 230 026000.0 2008 Hmmp Annual Fee $240.00 5 Chems @ $15.00 Each $75.00 0Z 10% Late Charge $31.50 j TOTAL $346.50 GUARANTOR DOB DR LIC NO AUTO LIC NO PRIOR STREET CITY ST ZIP CODE I EMPLOYER NAME EMPLOYER PHONE NO HD SUPPLY WATERWORKS LTD (WW7833) 407-822-2822 EMPLOYER STREET CITY ST ZIP CODE 1615 S STOCKTON ST LODI CA 95240 &FIQ SE- CO—OWNER AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO I I EMPLOYER NAME EMPLOYER PHONE NO HD SUPPLY WATERWORKS LTD(WW7833) 407-822-2822 EMPLOYER STREET CITY ST ZIP CODE 1615 S STOCKTON ST LODI CA 95240 REPARED BY CHECKED BY ATE / 6 9 COL. 20(3/33)