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. ` - TO: ICE OF REVENUE AND RECOVERY <br /> CPG # ACCOUNT TRANSMITTAL JJREFERRAL CoFy <br /> ACCOUNT NO. DEPT.NO. <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> INDUSTRIAL MOBILE SERVICES <br /> C/O NAME GUARANTOR SSN <br /> JAMES A YATES <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2735 TEEPEE DR #BSTOCKTON CA 95205 209-610-8942 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> OAKDALE CA 95361 209-465-7499 <br /> 13324 LAMBUTH RD <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM PYMT PR B <br /> INT MONTHLY PAY AMT ATF <br /> 10479 HAZMAT 3/15/09 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST <br /> MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGEDEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 1 Chem @ $15.00 $15.00 <br /> 10% Late Charge $25.50 <br /> State Surcharge Fee $24.00 <br /> TOTAL $304.50 <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 /> INDUSTRIAL MOBILE SERVICES 209-610-8942 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2735 TEEPEE DR#B STOCKTON CA 95205 <br /> &FAi�S <br /> g- CO-OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> INDUSTRIAL MOBILE SERVICES 209-610-8942 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2735 TEEPEE DR#B STOCKTON CA 95205 <br /> REPARED BYCHECKED BY DATE j Z� i `� COL. 20 (area) <br /> X/ �` / <br />