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:PG # TO: �CE OF REVENUE AND RECOVERY • <br /> ACCOUNT TRANSMITTAL Copy <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> 111 0 26 000.0 11/8/02 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> GOLDEN GATE ORN IRON WORKS <br /> C/O NAME GUARANTOR SSN <br /> JESUS T VALENZUELA <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 2489 E MINER AVE STOCKTON CA 95205 209-941-4090 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 209-941-4090 <br /> USER REFERENCE NO. IBILLI STATI CYCLEI STATUS DATE BMC CBMC INT MONTHLY PAY AMT <br /> 6139 HAZMAT I I I I I I I I I I I I 1 11 9/25/02 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> nQR <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 2002 Hmmp Annual Fee $240.00 Business Owners: <br /> 3 Chems @ $15.00 Each $45.00 Jesus & Manuela <br /> 10% Late Fee $28.50 24-hour = 983-8730 <br /> 4/15/02, 5/14/99, <br /> 5/15/98, 6/5/95, <br /> TOTAL $313.50 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> GOLDEN GATE ORN IRON WORKS 209-941-4090 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2489E MINER AVE STOCKTON CA 95205 <br /> S13OUSE CO—OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> VALENZUELA MANUELA <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> GOLDEN GATE ORN IRON WORKS 209-941-4090 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 2489 E MINER AVE STOCKTON CA 95205 <br /> PREPARED BYE,. - CHECKE _ _ DATE <br /> 11/8/02 <br /> (� COL 20 (NSA <br />