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CPG # TO: OFFICE OF REVENUE AND RECOVERY PQ <br /> ACCOUNT TRANSMITTAL s C0ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLC LAST - AKA - FIRST MI TITLE <br /> CONTINENTAL MUFFLER <br /> C/O NAME GUARANTOR SSN <br /> HECTOR OSORIO <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 230 E LODI AVE LODI CA 95240 209-368-1360 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3606 HEPBURN CIR STOCKTON CA 95209 N/A <br /> PYMI PROB <br /> USER REFERENCE NO. BILL hTAT ICYCLE ISTATUS DATEI BMCJ CBM INT MONTHLY PAY AMT <br /> 9829 HAZMAT 4/15/11 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> Daw <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. CRI N ,: AMOUNT <br /> 230 042000.0 2011 Hazmat Fee $100.00 380 042000.0 <br /> 230 042000.0 Haz Mat Penalty Fee $10.00 380 042000.0 <br /> 380 042000.0 Sm Hw Gen <5 Tons/yr $213.00 380 042000.0 <br /> 380 042000.0 Permit Fee Penalty $213.00 380 042000.0 <br /> 380042000.0 State Surcharge Fee $24.00 360 042000.0 <br /> 380 042000.0 Electronic Surcharge Fee $25.00 380 042000.0 <br /> 380 042000.0 380 042000.0 <br /> TOTAL $585.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CONTINENTAL MUFFLER 209-368-1360 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 230 E LODI AVE LODI CA 95240 <br /> CO-OWNER <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I 1 <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CONTINENTAL MUFFLER 209-368-1360 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 230 E LODI AVELODI CA 95240 <br /> REPARED BY CHECKED BY DATE 702 7-/ COL. zo (J/Be1 <br />