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CPG # TO: Ofy,-'E OF OE AND RECOVERY COPY <br /> ACCOUNTUNT TRANSMITTAL <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> FREMONT SHELL <br /> C/O NAME GUARANTOR SSN <br /> MICHAEL A DOMINGUEZ <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2494 E FREMONT ST STOCKTON CA 95205 209-941-8743 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2494 E. FREMONT ST STOCKTON CA 95205 209-941-8743 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT <br /> 8666 HAZMAT 3/15/12 <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVIC DATE: DATE OF <br /> STA STOP MED REC NO CHARGE - <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> NA <br /> 230 042000.0 2012 Hazmat Fee $130.00 <br /> 30 1 042 Oo 0 Hazmat Penalty Fee $13.00 <br /> p8q I q429OOtO I Invoice#0223626 <br /> 80 0 2 000 Invoice#0220314 <br /> B 0142900,0 Follow Up Non Comp $62.50 <br /> 80 002qOO.p Service Charge Penalty $18.75 <br /> TOTAL $224.25 <br /> GUARANTOR <br /> PRIOR STREET ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> FREMONT SHELL 209-941-8743 <br /> EMPLOYER STREET CITY STZIP CODE <br /> 2494 E FREMONT ST STOCKTON CA 95205 <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> FREMONT SHELL 209-941-8743 <br /> EMPLOYER STREET <br /> 2494 E FREMONT ST STOCKY CA 95205 <br /> CHECKED BY 112ATE COL. 20 (3188) <br />