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O: OFFICE OF REVENUE & RECOVERY <br /> CPG: ACCOUNT TRANSMITTAL <br /> ACCOUNT NO DEPT NO REFERRAL DATE <br /> 0420000 <br /> LAST- -GUARANTOR. FIRST MI LAST AHA FIRST MI <br /> Ott Walt <br /> C/O NAME SSN/FED# DR. LIC.NO. <br /> Performance Machine <br /> MAILING STREET CITY ST ZIP AREA PHONE# <br /> 11667 Palm Ln Unit F Manteca CA 95336 <br /> FACILITY ADDRESS CITY ST <br /> 11667 Palm Ln Unit F Manteca CA 95336 <br /> USER REFERENCE NO <br /> Invoice#238035 <br /> COMMENTS: <br /> SERVICE DATE: <br /> START: 2/1/13 STOP: 2/1/13 <br /> CHARGECHARGE <br /> NO DEPT NO DESCRIPTION AM"""- DESCRIPTION AMOUNT <br /> Inv#238035 <br /> 230 2013 Hazmat Fee Ib123 <br /> 380 State Surcharge Fee <br /> 230 Haz Mat Penalty <br /> TOTAL 332.00 <br /> EMPLOYER NAME/SOURCE OF INCOME: EMPLOYER PHONE# <br /> EMPLOYER STREET CITY ST ZIP <br /> PREPARED BY: DATE: 3 <br /> REVIEWED BY: DATE: <br /> VkI" <br />