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CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> I( 642000 0 z�o <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> ELON INC(CLOSED) <br /> C/O NAME GUARANTOR SSN <br /> RICHARD EVANS I I I I I Robert Evans, Manager <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 17333 S COMCONEX RD MANTECA CA 95336 209-481-5180 <br /> RESIDENCE STREET CITY ST ZIPCODE AREA PHONE NO. <br /> 891 MONTICELLO LANE MANTECA CA 95336 209-481-5180 <br /> USER REFERENCE NO. BILL kTAT CYCLE STATUS DATE BMd CBM INT MONTHLY PAY AMT T <br /> 12138 HAZMAT 1.3/15/09 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NOMARRATIVE <br /> J I I <br /> SERVICE DATE: DATE OF <br /> START I STOP MED REC NO CHARGE Tax I0868-0246286 <br /> 0 49 P91 91 29 0 <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 230 026000 6 Chems @ $15.00 Each $90.00 <br /> 30 I 92qO010 10% Late Charge $33.00 <br /> 80 94400P State Surcharge Fee $24.00 <br /> 80 94 00,0 Sm Hw Gen<5tons/yr $213.00 <br /> 80 9400pPermit Fee Penalty $213.00 <br /> Invoice if 184707 <br /> TOTAL $813.00 <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 /> ELON INC(CLOSED) 209-481-5180 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 17333 S COMCONEX RD MANTECA CA 95336 <br /> S-PANSE- CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. I DOB DR LIC NO AUTO LIC NO <br /> 111 11111111 <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO � tl <br /> ELON INC(CLOSED) 209-481-5180 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 17333 S COMCONEX RD MANTECA I CA 95336 <br /> REPARED BY 9 1 CHECKED Ely JDATE O� COLIT- <br /> p lareel <br /> i <br /> 1 .� � Oma' \ <br />