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TO: OFFICE OF REVENUE & RECOVERY <br /> CPG: ACCOUNT TRANSMITTAL <br /> ACCOUNT NO DEPT NO REFERRAL DATE <br /> e23e�-62 2 <br /> 0420000 /B 5 02 <br /> LAST- -GUARANTOR- FIRST MI LAST AKA FIRST MI <br /> Evans, Robert <br /> ao NAME SSNI FED# DR.LIC.NO. <br /> Elon Inc <br /> MAILING STREET CIN ST ZIP AREA PHONE# <br /> 891 Monticello Ln Manteca CA 95336 209 481-5180 <br /> FACILITY ADDRESS CITY ST <br /> 17333 S Comconex Rd IManteca CA 95336 209 481-3442 <br /> USER REFERENCE NO <br /> Invoice#223858 <br /> COMMENTS: <br /> SERVICE DATE: <br /> START STOP <br /> 1/2712012 1/2712012 <br /> C ARGE CHARGE <br /> NO DEPT NO DESCRIPTION AMOUNT No DEPT NO DESCRIPTION AMOUNT <br /> Invoice#223858 <br /> 380 042000 0 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 NAMEISOURCE OF INCOME: EMPLOYER PHONE# <br /> EMPLOYER STREET CIN ST ZIP <br /> PREPARED BY: DATE: <br /> REVIEWED BY: DATE: /DJ= <br />