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CPG # TO: ' VICE OF REVENUE AND RECOVERY <br /> %r ACCOUNT TRANSMITTAL I-/ COPY <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLELAST - AKA - FIRST MI TITLE <br /> CHARLIE'S AUTO PARTS &HARDWARE I J 11 11 <br /> C/O NAME GUARANTOR SSN <br /> STANLEY POWERS <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 4515 E MAIN ST STOCKTON CA 95215 209-466-0841 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 10736 ELKHORN DR STOCKTON CA 95209 209-957-6229 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BMd CBM INT MONTHLY PAY AMT B <br /> 12030 HAZMAT 3/15/09 RA nATP <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START f STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO, DESCRIPTION AMOUNT CHARGE1 DEPT. NO. DESCRIPTION AMOUNT <br /> mn <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 2 Chems @ $15.00 Each $30.00 <br /> 10% Late Charge $27.00 <br /> State Surcharge Fee $24.00 <br /> TOTAL $321.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CHARLIE'S AUTO PARTS& HARDWARE 209-466-0841 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 4515 E MAIN ST STOCKTON CA 95215 <br /> SPOUS& CO—OWNER <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CHARLIE'S AUTO PARTS & HARDWARE 209-466-0841 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 4515 E MAIN ST STOCKTON CA 95215 <br /> PREPARED BY CHECKED BY ATE Coy. 20 (areal <br /> 6 <br />