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CPG # TO: DICE OF REVENUE AND RECOVERY • COPY <br /> 1 ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> GUZMAN AUTO REPAIR III IIIIIIIIIIII <br /> C/O NAME GUARANTOR SSN <br /> GUZMAN AUTO REPAIR <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> GUZMAN AUTO REPAIR 1037 W YOSEMITE AVE MANTECA CA 95337 209-239-2819 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> USER REFERENCE NO. BILL bTAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT PYMT PROB <br /> 8559 HAZMAT 11/15/09 <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 HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> Kir)230 026000.0 2008 - 2009 Hmmp <br /> Annual Fee $140.00 <br /> 2 Chems @ $15.00 <br /> Each Year $60.00 <br /> 10% Late Charge $20.00 <br /> TOTAL $220.00 <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 /> GUZMAN AUTO REPAIR 209-239-2819 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1037 W YOSEMITE AVE MANTECA CA 95337 <br /> SFOUS& 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 /> GUZMAN AUTO REPAIR 209-239-2819 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1037 W YOSEMITE AVE ; NTE A CA 95337 <br /> REPARED BV CHECKED BY 4 TE /�� coy. 20 Israel <br />