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CPG•# TO: OF <br /> E OF REVENUE AND RECOVERY <br /> * <br /> Arr()TTNT TRANSMITTAL <br /> CO <br /> ACCOUNT NO. DEPT.NO. REFERRALPY <br /> I I "I <br /> 1 026000.0 1 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST AKA FIRST MI TITLE <br /> J&M TRANSMISSIONS I � <br /> C/O NAME GUARANTOR SSN <br /> MAURICIO URTEAGA <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 7944 W 11TH ST #FTRACY CA 95304 209-833-7955 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 4196 ESCATTA AVE TRACY CA 95377 209-833-7955 <br /> USER REFERENCE NO. IBILL kTAT ICYCLE ISTATUS DATE I BM d CBM d INMONTHLY PAY AMT I PYMT I PROB <br /> Q11P DATE TERM DAT-F- <br /> 8722 HAZMAT 1.3/1,5/1.2 1 <br /> LAST - RECIPIENT CIPIENT FIRST MI TITLE USER REFERENCE NO/NARRATIVE <br /> SERVICED TE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> i i I I I I I i I I I I I <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> 230 042000.0 2012 Hazmat Fee $100.00 8 1 P4300P.0 <br /> 30 1 014290010 1 Hazmat Penalty Fee $10.00 8 1 104300P.0 1 1 <br /> p8q I q4290010 , Sm Hw Gen <5 Tons/yr $213.00 p8q 1 P43009-01 1 <br /> 8 <br /> �8q I 0I42q0010 11 Permit Fee Penalty $213.00 8 1 4 <br /> Pol I 042Q00,0 State Surcharge Fee $24-00 1 p8q 1 P43009.01 1 <br /> �8� 1 0I42900j0 Electronic Surcharge Fee $25.00 p8q 1 P43009.01 1 <br /> ?801 .1 002q0010 I p8q P43009.01 1 <br /> TOTAL $585.00 <br /> Dog DR I ir.NO���l ITO I IC N C-W RANTOR <br /> PRIOR STREET CITY qT ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> J&M TRANSMISSIONS 209-833-7955 <br /> EMPLOYER STREET CITY STT---ZIP CODE <br /> 7944 W 11TH ST#F TRACY I CA 195304 <br /> AST FIRST MI TITLE J SOC SEC-NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYERPHONENO <br /> J&M TRANSMISSIONS 209-833-7955 <br /> EMPLOYERSTREET CITY ::��p ronr <br /> 17944 W 11TH ST#F T ;X 1 CA 1 95304 <br /> gFpAgrn BY 1",2y_L1 , I CHECKED BY JDATE .1 COL. 20 affis) <br />