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CPG '# TO: OFFICE C REVENUE AND RECOVERY 'I�I; p� <br /> fik ACCOUNT TRANSMITTAL <br /> MW ACCOUNT NO. DEPT. NO, <br /> REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> CREATIVE RESEARCH MANAGEMENT <br /> C/O NAME GUARANTOR SSN <br /> CREATIVE RESEARCH MGMT INC <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2029 E HARDING WAY STOCKTON CA 95205 209-938-0900 EXT <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 209-938-0900 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT <br /> PYMT PROS <br /> 10411 HAZMAT 3/20/10 <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 /> 230 026000.0 2010 Hazmat Fee $360.00 <br /> State Surcharge Fee $24.00 <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $36.00 <br /> VA <br /> TOTAL $445.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTOLIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CREATIVE RESEARCH MANAGEMENT 209-938-0900 EXT <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2029 E HARDING WAY STOCKTON CA 95205 <br /> Sp9�ST} 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 /> CREATIVE RESEARCH MANAGEMENT 209-938-0900 EXT <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2029 E HARDING WAY STOC ON CA 95205 <br /> CHECKED BY DATE YIa. g//0 COL 20 (3188) <br /> REPARED BY <br />