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CPG+ # TO: 0 •FICE OF REVENUE AND RECOVERY <br /> r, ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. <br /> DEPT.NO. REFERRAL 0 D <br /> 02600010 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> JL WELDING <br /> C/O NAME GUARANTOR SSN <br /> LARRY MEYER <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO, <br /> 896 STOKES AVE STOCKTON CA 95215 209-467-4337 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 9372 E MARIPOSA RD STOCKTON CA 95215 209-467-4337 <br /> USER REFERENCE NO, BILL TAT CYCLE STATUS DATE BMd CBMd IN MONTHLY PAY AMT <br /> Ml IP MATP -F- <br /> 10692 HAZMAT 3/15/12 1 TERM OAT <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> TA T STOP MED REC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT, NO. DESCRIPTION AMOUNT <br /> pip idf� <br /> 230 042000.0 2012 Hazmat Fee $285.00 p8q <br /> 1 1 <br /> 30 042 90010 Hazmat Penalt Fee $28.50 pSq1043009.01 <br /> 8 42 00 0 State Surcharge Fee $24.00 8 4 00 .0 <br /> p8q I 0I42q0010 I lectronic Surcharge Fee $25.00 p8q <br /> 1 1 <br /> 80 1 014290010 8P43009.01 <br /> 80 1 014290010 Pq 11 P43009.01 <br /> 80 1 0 2qOO.p I p8q <br /> 1 1 <br /> TOTAL $362.50 <br /> GUARANTOR <br /> PRIG STREET rITY ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> JL WELDING 209-467-4337 <br /> EMPLOYER STREET CITY T ZIP CODE <br /> 896 STOKES AVE STOCKTON CA 95215 <br /> AST FIRST MI TITLE SOC SEC N0, DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> JL WELDING 209-467-4337 <br /> EMPLOYER STREET CITY ST 71P ronF <br /> 896 STOKES AVE T KT CA 95215 <br /> CHECKED BY IDATE COL 20 (3188) <br />