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CPG # TO: ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL • <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> 1 1 1 1 1 1 1 1 1.." A- C (opy <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> DOPACO INC(PERFORMANCE DR) <br /> C/O NAME GUARANTOR SSN <br /> DOPACOINC <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> DOPACO INC (PERFORMANCE DR)4545 QANTAS LN STOCKTON CA 95206-4997 209-983-3140 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 100 ARRAN DALE BLVD EXTON PA 19341 610-524-8500 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BMd CBMd INT MONTHLY PAY AMT P MT PROBI <br /> 9023 HAZMAT 3115109 <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 CHARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2009 Hmmp Annual Fee $240.00 <br /> 8 Chems 9 $15.00 Each $120.00 <br /> 10% Late Charge $36.00 <br /> State Surcharge Fee $24.00 <br /> low <br /> TOTAL $420.00 <br /> GUARANTOR <br /> EDOB DR LIC NO AUTO LIC NO <br /> STREET CITY ST ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> DOPACO INC(PERFORMANCE DR) 209-983-3140 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1110 PERFORMANCE DR STOCKTON CA 95206-4997 <br /> SPOUsa CO—OWNER <br /> I.AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> DOPACO INC(PERFORMANCE DR) 209-983-3140 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1110 PERFORMANCE DR STOCKTON CA 9/5206-4997 <br /> PREPARED BY CHECKED BY JDATE :f �,� I COL. 20{steal <br />