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CPG # TO:o . OWE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST AKA FIRST MI TITLE <br /> COMPLETE AUTO BODY&PAINT <br /> CIO NAME GUARANTOR SSN <br /> DAVID BEARY JR <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 335 E WETMORE ST #5MANTECA CA 95337-5700 209-825-7250 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 209-825-7250 <br /> USER REFERENCE NO. BILL STAI CYCLE STATUS DATE BMd CBMC INT I MONTHLY PAY AMTPR <br /> ATE <br /> 9174 HAZMAT 1 11 , 11 , 141151161 111 , <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENTDOR 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 /> NONO <br /> 230 026000.0 2006 Hmmp Annual Fee $240.00 <br /> 2 Chems @ $15.00 Each $30.00 <br /> 10% Late Charge $27.00 <br /> State Service Fee $24.00 <br /> Sm Hz Gen <5 Tons/yr $200.00 <br /> Permit Fee Penalty $200.00 <br /> TOTAL $721.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> COMPLETE AUTO BODY&PAINT 209-825-7250 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 335 E WETMORE ST#5 MANTECA CA 95337-5700 <br /> SPAHSB CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> COMPLETE AUTO BODY&PAINT 209-825-7250 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 335 E WETMORE STT##55 MANTECA CA 95337-5700 <br /> PREPARED B�—/ �� CHECKED BY DATE Z ` COL 90 [area <br />