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CPG # TO: r--BICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL 1.40 COPY <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> HUFFCOINC <br /> C/O NAME GUARANTOR SSN <br /> CHARLES DALE HUFF <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 4447 S AIRPORT WAY STOCKTON CA 95206 209-983-4930 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3541 LAKE FRONT CIR STOCKTON CA 95209 209-983-4930 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT P <br /> 10153 HAZMAT I I I I I I I I I 1 1 1.3/1,5/0.9 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NONARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 6 Chems @ $15.00 Each $90.00 <br /> 10% Late Charge $33.00 <br /> State Surcharge Fee $24.00 <br /> TOTAL $387.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> HUFFCO INC 209-983-4930 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 4447 S AIRPORT WAY STOCKTON CA 95206 <br /> S-PAHSB CO—OWNER <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> HUFFCO INC 209-983-4930 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 4447 S AIRPORT WAY STOCKTON CA 5206 <br /> REPARED BY CHECKED BY DATE COL. 20(38) <br /> i j <br />