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C-4 # TO: of ICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL COPY <br /> ACCOUNT NO. DEPT.NO. REFERR <br /> DATE <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> CUSTOM METAL FINISHING <br /> C/O NAME GUARANTOR SSN <br /> NEIL DAVIS&TERRI TAYLOR <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1550 SHAW RD #CSTOCKTON CA 95215 209-505-0037 <br /> RESIDENCE STREET CITY ST ZIPCODE AREA PHONE NO. <br /> 4212 ELDENBERRY CT MODESTO CA 95356 209-918-0815 <br /> USER REFERENCE NO. BILL STA CYCLE STATUS DATE BM CBMC INT MONTHLY PAY AMT <br /> Q1 IF DATE TERM DATE <br /> 9554 HAZMAT 3/15/08 <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 /> NONO <br /> 230 026000.0 2008 Hmmp Annual Fee $240.00 <br /> 8 Chems @ $15.00 Each $120.00 <br /> 10% Late Charge $36.00 <br /> State Surcharge Fee $24.00 <br /> Sm Hw Gen <5tons/yr $213.00 <br /> Permit Fee Penalty $213.00 <br /> TOTAL $846.00 <br /> GUARANTOR <br /> DOB DRLICNO---F AUTO LIC NO <br /> PRIOR STREET CITY ST ZIP CODE <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CUSTOM METAL FINISHING 209-505-0037 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1550 SHAW RD#C STOCKTON CA 95215 <br /> &�'' CO-OWNER <br /> LAST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> CUSTOM METAL FINISHING 209-505-0037 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1550 SHAW RD#C STOCKTON CA 95215 <br /> PREPARED BY I CHECKED BY _ DATE COL. 90 (TAA <br /> , � �7 � g <br />