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CPG # TO: OFFICE OF REVENUE AND RECOVERY <br /> ACCOUNT TRANSMITTAL PID <br /> � <br /> ACCOUNT NO. DEPT. NO. REFERRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> WES DAY GATE SYSTEMS <br /> C/O NAME GUARANTOR SSN <br /> STEVEN NORRIS <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 6909 TAM O'SHANTER DR STE BSTOCKTON CA 95210 209-951-4445 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 9339 SINGLE TREE CT. STOCKTON CA 95209 209-951-5734 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATEI BMd CBMd INT MONTHLY PAY AMT I PYMT <br /> 14115 HAZMAT 1.3/20/1.0 <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 /> mn <br /> 230 026000.0 2010 Hazmat Fee $300.00 <br /> State Surcharge Fee $24.00 JIL <br /> Electronic Surcharge $25.00 <br /> Hazmat Penalty Fee $30.00 a AfOl p,;. <br /> Se' <br /> TOTAL $379.00 <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 /> WES DAY GATE SYSTEMS 209-951-4445 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 6909 TAM O'SHANTER DR STE B STOCKTON CA 95210 <br /> SFAU,88 CO-OWNER <br /> AST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> EMPLOYER NAME EMPLOYER PHONE NO I I <br /> WES DAY GATE SYSTEMS 209-951-4445 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 6909 TAM O'SHANTER DR S;p STOCKTON CA 95210 <br /> PREPARED BY I CHECKED BY ATE �/ 9116 <br /> /e COL. M (3M) <br />