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'CPG lv TO: OFFICE OF REVENUE AND RECOVERY <br /> • ACCOUNT TRANSMITTAL . (C�^'\ p n <br /> ACCOUNT NO. DEPT.NO. REFERRAL U j'(Jurj V <br /> 026000.0 9/26/02 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> A-1 AUTO SERVICE <br /> C/O NAME GUARANTOR SSN <br /> BALJIT GILL <br /> MAILING STREET CITY ST ZIPCODE AREA PHONE NO. <br /> 1850 N MAIN ST MANTECA CA 95336 408-210-4580 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1962 EVERGLADES DR MILPITAS CA 95035 408-945-1313 <br /> USER REFERENCE NO. I BILLI STAI CYCLEI STATUS DATEI BM C13MCI INT IMONTHLY PAY AMT <br /> AT RM DATE <br /> 10139 HAZMAT 7/22/02 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USERREFERENCE NO/NARRATIVE <br /> DOS <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT.NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> NONO <br /> 230 026000.0 2001 Hmmp Annual Fee $70.00 Business Owner: <br /> 2 Chems @ $15.00 Each $30.00 1 1 1 1 1 1 1 BallitI <br /> ll <br /> 10% Late Charge $10.00 <br /> 2002 Hmmp Annual Fee $70.00 <br /> 2 Chems @ $15.00 Each $30.00 <br /> 10% Late Charge $10.00 <br /> TOTAL $220.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> A-1 AUTO SERVICE 408-210-4580 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1850 N MAIN ST MANTECA CA 95336 <br /> SPIE CO—OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> A-1 AUTO SERVICE 408-210-4580 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1850 N MAIN ST MANTECA CA 95336 <br /> REPARE9JP -� d��7� � /, /J/, C E BY DATE 9/26/02 <br /> r/�//<!%IJX<�� ��U.•, Y/ COL 20 (3188 <br /> r <br />