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CPG # TO: 7ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL C 0 py <br /> ACCOUNTNO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> SUPER SMOG & REPAIR III , till [ IJ11A . , <br /> C/O NAME GUARANTOR SSN <br /> ROBERT VASQUEZ <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 511 N AMERICAN ST STOCKTON CA 95202 209-467-8737 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 209-467-8737 <br /> USER REFERENCE NO. IBILL TAT ICYCLE ISTATUS DATEI BMd CBMd INTI MONTHLY PAY AMT MT B <br /> 13397 HAZMATI It 1.7/15/09 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> V2330 <br /> STOP MED REC NO CHARGE <br /> DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 026000.0 2007 - 2009 Annual <br /> Hmmp Fee $210.00 <br /> 1 Chem @ $15.00 <br /> Each Year $45.00 <br /> 10% Late Charge $25.50 <br /> TOTAL $280.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> SUPER SMOG& REPAIR 209-467-8737 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 511 N AMERICAN ST STOCKTON CA 95202 <br /> SPOUS& CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> SUPER SMOG & REPAIR 209-467-8737 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 511 N AMERICAN ST STOCKTON ,Y 6 ' CA 95202 <br /> REPARED BY id CHECKED BY JDATE COL. zo IaiMel <br />