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CPG # - TO: 'ICE OF REVENUE AND RECOVERY C 0 � '_ )'M <br /> �- ACCOUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> DELL-TRAC CONSTRUCTION INC <br /> C/O NAME GUARANTOR SSN <br /> DALE DELUARINGA <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> DELL-TRAC CONSTRUCTION INC P.O. BOX 5159 STOCKTON CA 95205 209-373-8135 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3635 W. COUNTRY CLUB STOCKTON CA 95204 209-373-8135 <br /> USER REFERENCE NO. BILL kTAT CYCLE STATUS DATE BMI CBMd INTI MONTHLY PAY AMT I PYMTPR B <br /> 13873 HAZMAT 7/15/09 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NOINARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> Nr)230 026000.0 2008 & 2009 Annual <br /> Hmmp Fee $140.00 <br /> 1 Chem @ $15.00 <br /> Each Year $30.00 <br /> 10% Late Charge $17.00 <br /> State Surcharge Fee $24.00 <br /> TOTAL $211.00 <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 /> DELL-TRAC CONSTRUCTION INC 209-373-8135 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 3732 E FARMINGTON RD STOCKTON CA 95215 <br /> SPOU68 CO—OWNER <br /> AST FIRSTMI TITLE SOC SEC NO. DOB OR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> DELL-TRAC CONSTRUCTION INC 209-373-8135 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 3732 E FARMINGTON RD STOCKTON Z.- CA 95215 <br /> REPARED BY <br /> CHECK BY DATE COL. 20 (3188) <br /> /, <br />