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CPG # TO: C-"ICE OF REVENUE AND RECOVERY <br /> CO P <br /> ��]ACCOUNT TRANSMITTAL V <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> CROSSROADS AUTOMOTIVE (CLOSED) I 11JI Jill III <br /> C/O NAME GUARANTOR SSN <br /> BRENT BERKNBILE <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> CROSSROADS AUTOMOTIVE (CLOSED)600 N ELDORADO ST STOCKTON CA 95202 209 271 9171 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2505 W FREMONT ST STOCKTON CA 95203 209-271-9171 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT MT B <br /> 13612 HAZMAT it 11 1 1 1 1 1 1 1 1 1 1 1 1.7/15/09 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2005 - 2008 Annual <br /> Hmmp Fee $960.00 <br /> 3 Chems @ $15.00 <br /> Each Year $180.00 <br /> 10% Late Charge $114.00 <br /> Statte Surcharge Fee $24.00 <br /> TorAL $1278.00 <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 /> CROSSROADS AUTOMOTIVE (CLOSED) 209 271 9171 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 815 E WEBER AVE STOCKTON CA 95202 <br /> SPAUS& 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 /> CROSSROADS AUTOMOTIVE (CLOSED) 209 271 9171 <br /> EMPLOYER STREET CITY - ST ZIP CODE <br /> 815 E WEBER AVE STOCKTON &WC CA 95202 <br /> REPAR I CHECKED BY I JDATE COL. 20 (3M) <br />