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CPG # .A TO: ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL <br /> ACCOUNT ND. DEPT. NO. PATC COPY <br /> REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA FIRST MI TITLE <br /> CENTER AUTO REPAIR <br /> CIO NAME GUARANTOR SSN <br /> HA TRAN <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1587 TURNPIKE RD STOCKTON CA 95206 209-948-0832 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1551 PRAIRE LN STOCKTON CA 95209 209-948-0832 <br /> USER REFERENCE NO. BILL kTAT CYCLE STATUS DATE BMd C80 INT MONTHLY PAY AMT I PYMT PNJQATF <br /> R B <br /> 6890 HAZMAT 12/15/08 <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 _CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2007 & 2008 Hmmp (� <br /> Annual Fee $140.00 <br /> 4 Chems Co) $15.00 <br /> Each Year $120.00 " y <br /> 10% Late Charge $26.00 <br /> TOTAL $286.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY S7 I ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CENTER AUTO REPAIR 209-948-0832 <br /> EMPLOYER STREET I CITY ST I ZIP CODE <br /> 1587 TURNPIKE RD STOCKTON CA 95206 <br /> S LOUEP& CO—OWNER <br /> AST FIRST MI TITLE SOG SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I ---- - I- I I I I I I I I 1 11 1 1 1 I I- I t I ]I I I I 1 I 1 <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CENTER AUTO REPAIR 209-948-0832 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1587 TURNPIKE RD STOCKTON CA 95206 <br /> REPARaEEDD BY CHECKED BY JDATE , <br /> ����� COL. 20 (3188) <br /> C�2� XF <br />