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CPG # h TO: (•ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL C� <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> ARTISTIC ORNAMENTAL IRON WORKS <br /> C/O NAME GUARANTOR SSN <br /> ALEX&ERNESTO GONZALEZ <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2228 N WILSON WAY STOCKTON CA 95205 209-598-7700 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1124 VICTORIA AVE STOCKTON CA 95203 209-465-7725 <br /> DI IF nAT TFRMQATE. <br /> USER REFERENCE NO. IBILLI STA CYCLEI STATUS DATEI BMd CBMCI INT MONTHLY PAY AMT <br /> I Rug- <br /> 2036 HAZMAT 1/24/05 <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 <br /> NO DEPT.NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2005 Hmmp Annual Fee $240.00 1 1 1 1 1 1 1 Sm Hw Gen <5 Tons $150.00 <br /> 3 Chems @ $15.00 Each $45.00 1 1 1 1 1 1 1 Permit Fee Penalty $150.00 <br /> 10% Late Charge $28.50 <br /> State Service Fee $24.00 <br /> TOTAL $637.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST LP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ARTISTIC ORNAMENTAL IRON WORKS 209-598-7700 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2228N WILSON WAY STOCKTON CA 95205 <br /> SPE)USH CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> GONZALES ERNESTO&ALEX <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ARTISTIC ORNAMENTAL IRON WORKS 209-598-7700 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2228 N WILSON WAY STOCKTON CA 95205 <br /> PREPARED BY CHECKED BY DATE /, /�S coy. zo raree <br />