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TO: OFFICE OF REVENUE & RECOVERY <br /> CPG: ACCOUNT TRANSMITTAL <br /> ACCOUNTNO DEPT NO REFERRAL DATE - <br /> 1177 33 S' 0420000 <br /> LAST- -GUARANTOR. FIRST MI LASt aro. FIRST MI <br /> Evans Robert <br /> C/O NAME SSN/FED# DR.LIC.NO. <br /> Elon Inc 68-0246286 <br /> MAILING STREET CITY ST ZIP AREA PHONE# <br /> 891 Monticello Ln Manteca CA 95336 (209)481-5180 <br /> FACILITY ADDRESS I CITY ST ZIP <br /> 17333 S Comconex Rd Manteca CA 95336 209 481-3442 <br /> USER REFERENCE NO <br /> Inv#211380 <br /> COMMENTS: <br /> SERVICE DATE: - <br /> START STOP <br /> 1/28/2011 1/2812011 <br /> CHARGE <br /> DEPT NO DESCRIPTION AMOUNT cxNO DEPT NO DESCRIPTION AMOUNT <br /> Inv#211380 <br /> 380 0420000 SM HW Gen Permit 213.00 <br /> 380 0420000 AST Facility Permit 675.00 <br /> 380 0420000 State Surcharge Fee 24.00 <br /> 380 0420000 Electronic Reporting 25.00 <br /> 380 0420000 Permit Fee Penalty 213.00 <br /> 380 0420000 Permit Fee Penalty 675.00 <br /> TOTAL 1,825.00 <br /> EMPLOYER NAMEISOURCE OF INCOME: EMPLOYER PHONE# <br /> EMPLOYER STREET CITY ST ZIP <br /> PREPARED BY: DATE: S� <br /> REVIEWED BY: DATE: it, <br />