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CPC # TO: ICE OF REVENUE AND RECOVERY . <br /> ACCOUNT TRANSMITTAL C ( F <br /> ACCOUNT NO. DEPT. NO. REFERRAL \(wJ�/{ u lu/ <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> SEI-SLABY ENVIRONMENTAL INC <br /> C/O NAME I I GUARANTOR SSN <br /> DEBBIE&ROBERT SLABY <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> SEI-SLABY ENVIRONMENTAL INC P.O. BOX 903 BORREGO SPRINGS CA 92004 760-767-0776 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 587 PALM CANYON DR BORREGO CA 92004 760-767-0776 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM INT MONTHLY PAY AMT P MTnATF PROB <br /> 13317 HAZMAT I 1 11 11 11 1 1 1 1 1 1 1 1 1 1.3/15/09 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NOMARRATIVE <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT HARGE DEPT. NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2009 Annual Fee $240.00 <br /> 3 Chems @ $15.00 Each $45.00 <br /> 10% Late Charge $28.50 <br /> State Surcharge Fee $24.00 <br /> low <br /> TOTAL $337.50 <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 /> SEI-SLABY ENVIRONMENTAL INC 760-767-0776 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 783 E ROTH RD FRENCH CAMP CA 95231 <br /> S-PAUS-T} CO—OWNER <br /> AST FIRST MI TITLE SOC SEC NO, DOB DR LIC NO AUTO LIC NO <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> SEI-SLABY ENVIRONMENTAL INC 760-767-0776 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 783 E ROTH RD FRENCH CAMP CA 9 1 <br /> PREPARED BY ICHECKED JDATE i Z 1U C COL. 20 (3/BB) <br /> Y' j <br />