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uC?G ;# __ T0: ICE OF REVENUE AND RECOVERY ,4,WV COPY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> DATE <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> GARCIA'S AUTO REPAIR&TOW <br /> C/O NAME GUARANTOR SSN <br /> EVARISTO LUNA GARCIA <br /> 11 <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 982 E WATERLOO RD STOCKTON CA 95206 209-465-9665 <br /> RESIDENCE STREET CITY ST ZIPCODE AREA PHONENO. <br /> 1609 SUNNYSIDE AVE STOCKTON CA 95205 209-465-9665 <br /> USER REFERENCE NO. I BILL STd CYCLE STATUS DATE BM CBMC INT I MONTHLY PAY AMT <br /> 12197 HAZMAT 7/6/05 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> OR <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> NONO <br /> 230 026000.0 2001 - 2005 Hmmp <br /> Annual Fee $350.00 <br /> 1 Chem @ $15.00 <br /> Each Year $75.00 <br /> 10% Late Charge $42.50 <br /> State Service Fee $24.00 <br /> TOTAL $491 .50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> GARCIA'S AUTO REPAIR&TOW 209-465-9665 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 982 E WATERLOO RD STOCKTON CA 95206 <br /> SfIGUSE: CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> GARCIA'S AUTO REPAIR&TOW 209-465-9665 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 982 E WATERLOO RD STOCKTON CA 95206 <br /> PREPARED BY / CHECKED BY Llt� � DATE// /S/DS coy. za ryee <br />