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CPG # TO: "ICE OF REVENUE AND RECOVERY <br /> %-w ACCOUNT TRANSMITTAL %Uol <br /> ACCOUNT NO. DEPT.NO. REFERRAL <br /> 026000.0 C (opy <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> ROCKITE CO <br /> CIO NAME GUARANTOR SSN <br /> NEIL DAVIS <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 1550 SHAW RD #DSTOCKTON CA 95215 209-918-0815 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO, <br /> 4212 ELDENBERRY CT MODESTO CA. 95356 209-918-0815 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBMC IN MONTHLY PAY AMT P M PROB <br /> 13907 HAZMAT 7/15/09 <br /> CHARGES <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> J I <br /> SERVICE DATE: DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT_ NO_ DESCRIPTION AMOUNT CHARGE Ain DEPT.NO. DESCRIPTION AMOUNT <br /> 230 026000.0 2008 & 2009 Annual <br /> Hmmp Fee $480.00 <br /> 1 Chem @ $15.00 <br /> Each Year $30.00 <br /> 10% Late Charge $51.00 ti <br /> State Surcharge Fee $24.00 <br /> TOTAL. $585.00 <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 /> ROCKITE CO 209-918-0815 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1550 SHAW RD#D STOCKTON CA 95215 <br /> SPOUS& CO-OWNER <br /> ST FIRST MI TITLE SOC SEC NO, DOB DR LIC NO AUTO LIC NO <br /> I .I.-LIJ I L - 1 L--A----L-- 11 fill I I I <br /> I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> ROCKITE CO 209-918-0815 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1550 SHAW RD#D STOCKTON -9,, &� C CA 95215 <br /> PREPARED BY CHECKED BY DATE CAL. 20 (3!&8) <br /> .w G <br />