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CPG # TO: 3ICE OF REVENUE AND RECOVERY <br /> ~ ACCOUNT TRANSMITTAL .�.ACCOUNT NO. DEPT. DATE COPY <br /> NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> JOHN ROSSI HAY CO <br /> C/O NAME GUARANTOR SSN <br /> JOHN ROSSI <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> JOHN ROSSI HAY CO P.O. BOX 332 MANTECA CA 95336 209-823-3965 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> P.O. BOX 332 MANTECA CA 95336 209-823-3965 <br /> USER REFERENCE NO. IBILLI STAI CYCLEI STATUS DATE BMCj CBMCI INT I MONTHLY PAY AMT <br /> nI IFDATE TERM DATE <br /> 5977 HAZMAT 3/15/08 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> DOB <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE <br /> NO DEPT.NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2008 Hmmp Annual Fee $240.00 <br /> 3 Chems @ $15.00 Each $45.00 <br /> 10% Late Charge $28.50 <br /> State Service Fee $24.00 <br /> Sm Hz Gen <5 Tons/yr $213.00 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $763.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO TiL <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> JOHN ROSSI HAY CO 209-823-3965 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 511 N AIRPORT WAY MANTECA CA 95336 <br /> OPeUSE CO—OWNER <br /> LAST FIRST MI TITLE SOC SEC NO, I DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> JOHN ROSSI HAY CO 209-823-3965 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 511 N AIRPORT WAY MANTEL CA 95336 <br /> PREPARED BYE 5?�VW4X CHECKED BY IDA <br /> ATEcoy. 20 lyse <br /> C 1 4i fs <br />