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CPG # T0: ("-BICE OF REVENUE AND RECOVERY copy <br /> ACCOUNT TRANSMITTAL If <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> V&J ORNAMENTAL IRON WORKS <br /> C/O NAME GUARANTOR SSN <br /> VICTOR RIVARN /JAIME SALAS <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1201 N FILBERT ST STOCKTON CA 95205 209-465-3407 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 209-465-3407 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT I PYMT <br /> 13231 HAZMAT 11/15/09 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> mn <br /> 230 026000.0 2005- 2009 Hmmp <br /> Annual Fee $1200.00 <br /> 3 Chems @ $15.00 <br /> Each Year $225.00 <br /> 10% Late Charge $142.50 <br /> TOTAL $1567.50 <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 /> V&J ORNAMENTAL IRON WORKS 209-465-3407 <br /> EMPLOYER STREET 7 CITY ST ZIPCODE <br /> 1201 N FILBERT ST STOCKTON CA 95205 <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 /> V&J ORNAMENTAL IRON WORKS 209-465-3407 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1201 N FILBERT ST STOC ON CA 95205 <br /> REPARED BY CHECKED BY ,c> DATE /G COL. 20(3188) <br />