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CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> t ACCOUNT TRANSMITTAL • COPY <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR -FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> PEPSI BOTTLING GROUP <br /> C/O NAME GUARANTOR SSN <br /> PEPSI COLA CO <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 4225 E PEPSI PL STOCKTON CA 95215 916-302-6252 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 4225 E PEPSI PL STOCKTON CA 95215 209-931-7209 <br /> USER REFERENCE NO. IBILL TAT ICYCLE ISTATUS DATEI BMd CBM INTI MONTHLY PAY AMT PYMT PRO <br /> Ir n <br /> 8956 HAZMAT 3/20/11 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT.NO. DESCRIPTION AMOUNT <br /> mn <br /> 380 042000.0 2011 Hazmat Fee $270.00 <br /> 380 042000.0 State Surcharge Fee $24.00 <br /> 380 042000.0 Electronic Surcharge $25.00 <br /> 380 042000.0 Hazmat Penalty Fee $27.00 <br /> 380 042000.0 <br /> 380 042000.0 <br /> 380 042000.0 <br /> TOTAL $346.00 <br /> GUARANTOR <br /> DOB DR LIC NO AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> 1 <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> PEPSI BOTTLING GROUP 916-302-6252 <br /> EMPLOYER STREET CITY ST ZIPCODE <br /> 4225 E PEPSI PL STOCKTON CA 95215 <br /> 5-P9USE- CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO I AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> PEPSI BOTTLING GROUP 916-302-6252 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 4225 E PEPSI PL STOCKTON I CA 95215 <br /> PREPARED BY CHECKED BY JDATECOL 20 career <br />