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CPG #_ TO: 0ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL Co <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> DATF <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST Ml TITLE LAST - AKA - FIRST MI TITLE <br /> GUZMAN AUTO REPAIR <br /> CIO NAME GUARANTOR SSN <br /> MARIA MESIAS <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 /> 815 SEQUOIA AVE. MANTECA CA 95337 510-861-6539 <br /> USER REFERENCE NO. 13ILLISTAI CYCLEIPROB DATE BM CBMC INT I MONTHLY PAY AMT 7gT, TPM DATE <br /> 8559 HAZMAT 3/15/07 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENTQQQ USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED AEC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE <br /> NO DEPT.NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2007 Hmmp Annual Fee $70.00 <br /> 2 Chems @ $15.00 Each $30.00 <br /> 10% Late Charge $10.00 <br /> State Service Fee $24.00 <br /> Sm Hz Gen <5 Tons/yr $206.00 <br /> Permit Fee Penalty $206.00 <br /> TOTAL $546.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CrrY ST ZIP CODE <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 /> SfeffSE CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <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 /> PREPARED B� CHECKED B GC Q�ATE&/1447 0 L. 20 (3188 <br />