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TO: OFFICE OF REVENUE & RECOVERY <br /> CPG: ACCOUNT TRANSMITTAL <br /> ACCOUNT NO DEPT NO REFERRAL DATE <br /> 9 /B ,S <br /> LAST- -GUARANTOR- FIRST MI LAST AKA FIRST MI <br /> Evans, Robert <br /> CIO NAME SSNI FED# DR.LIC.NO. <br /> Elon Inc 68-0246286 <br /> MAILING STREET CITY FST ZIP AREA PHONE# <br /> 891 Monticello Ln Manteca CA 95336 .(209)481-5180 <br /> FACILITY ADDRESS CITY ST <br /> 17333 S Comconex Rd Manteca CA 95336 209 481-3442 <br /> USER REFERENCE NO <br /> Invoice#223858 <br /> COMMENTS: <br /> SERVICE DATE: <br /> START STOP <br /> 1/2712012 1/27/2012 <br /> ONNO E DEPT NO DESCRIPTION AMOUNT ONNOOE DEPT NO DESCRIPTION AMOUNT <br /> Invoice#223858 <br /> 380 0420000 SM HW Gen Permit 213.00 <br /> AST Fac 10k-100k Gal 675.00 <br /> State Surcharge Fee 24.00 <br /> Electronic Rptg Surc 25.00 <br /> Permit Fee Penalty 213.00 <br /> Permit Fee Penalty 675.00 <br /> TOTAL 1,825.00 <br /> EMPLOYER NAME/SOURCE OF INCOME: EMPLOYER PHONE# <br /> EMPLOYER STREET CITY ST ZIP <br /> PREPARED BY: DATE: <br /> REVIEWED BY: DATE: <br />