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CPG '# > TO: OFFICE OF REVENUE AND RECOVERY <br /> ' ACCOUNT TRANSMITTAL �..! COPY <br /> ACCOUNT NO. DEPT.NO. RRAL <br /> 026000.0 <br /> LAST - GUARANTOR - FIRST MI TITLE LAST - AKA - FIRST MI TITLE <br /> IMPERIAL AUTO SPA <br /> C/O NAME GUARANTOR SSN <br /> FRANK REYNOSO <br /> MAILING STREET CITY ST ZIP CODE AREA PHONE NO <br /> 1211 S TURNPIKE RD STOCKTON CA 95206 (209)405-6915 <br /> RESIDENCE STREET CITY ST ZIP CODE AREA PHONE NO. <br /> 3738 MYKALA DRIVE STOCKTON CA 95212 (209)405-6915 <br /> USER REFERENCE NO. BILL TAT CYCLE STATUS DATE BM CBM IN MONTHLY PAY AMT <br /> 14173 HAZMAT 3/20/11 <br /> LAST - RECIPIENT - FIRST MI TITLE RECIPIENT USER REFERENCE NO/NARRATIVE <br /> ERVC DAT -- DATE OF <br /> START STOP MED REC NO CHARGE <br /> CHARGE DEPT. NO. DESCRIPTION AMOUNT CHARGE DEPT.NO. DESCRIPTION AMOUNT <br /> 230 042000.0 2012 Hazmat Fee $100.00 8P43009.01 Follow Up Non Comp $62.50 <br /> 30 1 014290010 1 Hazmat Penalty Fee $10.00 P89 P43009.0, Service Charge $18.75 <br /> p8q 1 q429OOrO Sm Hw Gen <5 Tons/yr $213.00 p8q P43009.0, <br /> P89 1 0 2 00 0 I Permit Fee Penalty $213.00 Invoice //0222427 <br /> 80 110 2 q0010 State Surcharge Fee $24.00 <br /> 80 0,42q0010 11 Electronic Surcharge Fee $25.00 <br /> Invoice #0226232 <br /> TOTAL 1 $666.25 <br /> GUARANTOR <br /> PRIOR STREET AT ZIP CODE <br /> I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> IMPERIAL AUTO SPA (209)405-6915 <br /> EMPLOYER STREET CITY ST ZIP CODE <br /> 1211 S TURNPIKE RD STOCKTON CA 95206 <br /> ST FIRST MI TITLE SOC SEC NO. DOB DR LIC NO AUTO LIC NO <br /> I I I <br /> EMPLOYER NAME EMPLOYER PHONE NO <br /> IMPERIAL AUTO SPA (209)405-6915 <br /> EMPLOYER STREET CITY RT 71P ronF <br /> 1211 S TURNPIKE RD STO T N CA 95206 <br /> VRFPARFn CHECKED BY IDATE coy- zo laiael <br />