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CPcG � TO: ,.FICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL COPY <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> G AND S OF JIMCO <br /> C/O NAME GUARANTOR SSN <br /> SUKHDEV SINGH <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> G AND S OF JIMCO 2717 CANYON DR MODESTO CA 95351 209-599-7261 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2717 CANYON DRIVE MODESTO CA 95351 209-495-0544 <br /> USER REFERENCE NO. BILL STAA CYCLE STATUS DATE BMC CBMC INT MONTHLY PAY AMT <br /> 8802 HAZMAT 3/15/08 <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 <br /> NO D5rt,NQ... DESCRIPTION AMOUNT <br /> 230 026000.0 2008 Hmmp Annual Fee $240.00 ,'rp <br /> 2 Chems @ $15.00 Each $30.00 ''" 1 <br /> 10% Late Charge $24.30 <br /> State Service Fee $24.00 <br /> Credit Ajustment -$27.00 <br /> TOTAL $291.30 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> G AND S OF JIMCO 209-599-7261 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1022 HIGHWAY 99 FRONTAGE RD RIPON CA 95366 <br /> GFeUSH CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> G AND S OF JIMCO 209-599-7261 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1022 HIGHWAY 99 FRONTAGE RD RIPON CA 95366 <br /> PREPARED BY I CHECKED BY . _ATE ,/ cOL. 20 11 <br /> T r <br />