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CPC # T0: OFFICE OF REVENUE AND RECOVERY COPY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO REFERRAL <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 /> GARCIA LUNA EVARISTO <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 982 E WATERLOO RD STOCKTON CA 95205 209-751-4044 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1609 SUNNYSIDE AVE STOCKTON CA 95205 209-465-9665 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBMCI INT MONTHLY PAY AMTIn, TFRNAnAT� <br /> PYMT PROBI <br /> iFnAT <br /> 12197 HAZMAT 3/20/10 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NOMARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> Nn <br /> 230 026000.0 2010 Hazmat Fee $85.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $8.50 <br /> TOTAL $142.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITYST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> GARCIA'S AUTO REPAIR &TOW 209-751-4044 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> —] <br /> 982 E WATERLOO RD STOCKTON CA 95205 <br /> SPGVfJ & CO—OWNER <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> GARCIA'S AUTO REPAIR &TOW 209-751-4044 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 982 E WATERLOO RD STOCKT CA 95205 <br /> PREPARED BY _ CHECKED BY DATE a /C cOL. zo c3�el <br />